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  • Print publication year: 2013
  • Online publication date: September 2013

Chapter 105 - Stereotactic procedures

from Section 22 - Neurologic Surgery


As in all fields of surgery, the current trend in neurosurgery is towards less-invasive procedures and the shorter hospital stays that result from them. Therefore, stereotactic techniques are an indispensable tool for the modern neurosurgeon and have been dramatically improved by the recent revolution in digital image guidance technology. These techniques provide a relatively straightforward, accurate, and safe method to approach intracranial targets that are defined by either anatomical or functional characteristics. Anatomically defined targets include brain tumors and abscesses, as well as other structural lesions. Targeting for anatomical disorders relies entirely on patient-specific anatomy derived from radiographs (e.g., ventriculography, rarely used today) or tomograms (e.g., CT, MRI) for localization. In addition, functional imaging modalities (e.g., fMRI), metabolic imaging modalities (e.g., positron emission tomography (PET)), and MR spectroscopy can be utilized in conjunction with other imaging modalities to help with target planning and visualization. Functionally defined structures include the various nuclei of the basal ganglia and thalamus that are targeted for pain and movement disorders (e.g., Parkinson's disease, essential tremor, and dystonia), as well as other conditions such as obsessive-compulsive disorder. Targeting for functional disorders typically combines computerized imaging with intraoperative electrophysiological mapping for localization, although anatomical techniques can be used alone as well.

Further reading
Air, EL, Leach, JL, Warnick, RE, McPherson, CM.Comparing the risks of frameless stereotactic biopsy in eloquent and noneloquent regions of the brain: a retrospective review of 284 cases. J Neurosurg 2009; 111: 820–4.
Chen, CC, Hsu, PW, Erich Wu, TW et al. Stereotactic brain biopsy: single center retrospective analysis of complications. Clin Neurol Neurosurg 2009; 111: 835–9.
Chernov, MF, Muragaki, Y, Ochiai, T et al. Spectroscopy-supported frame-based image-guided stereotactic biopsy of parenchymal brain lesions: comparative evaluation of diagnostic yield and diagnostic accuracy. Clin Neurol Neurosurg 2009; 111: 527–35.
Dammers, R, Haitsma, IK, Schouten, JW et al. Safety and efficacy of frameless and frame-based intracranial biopsy techniques. Acta Neurochir (Wien) 2008; 150: 23–9.
Hariz, MI.Complications of deep brain stimulation surgery. Mov Disord 2002; 17: S162–6.
Jain, D, Sharma, MC, Sarkar, C et al. Correlation of diagnostic yield of stereotactic brain biopsy with number of biopsy bits and site of the lesion. Brain Tumor Pathol 2006; 23: 71–5.
Kulkarni, AV, Guha, A, Lozano, A, Bernstein, M.Incidence of silent hemorrhage and delayed deterioration after stereotactic brain biopsy. J Neurosurg 1998; 89: 31–5.
Pantazis, G, Trippel, M, Birg, W, Ostertag, CB, Nikkhah, G.Stereotactic interstitial radiosurgery with the Photon Radiosurgery System (PRS) for metastatic brain tumors: a prospective single-center clinical trial. Int J Radiat Oncol Biol Phys 2009; 75: 1392–400.
Perez-Gomez, JL, Rodriguez-Alvarez, CA, Marhx-Bracho, A, Rueda-Franco, F.Stereotactic biopsy for brainstem tumors in pediatric patients. Childs Nerv Syst 2010; 26: 29–34.
Umemura, A, Jaggi, JL, Hurtig, HI et al. Deep brain stimulation for movement disorders: morbidity and mortality in 109 patients. J Neurosurg 2003; 98: 779–84.