06 functional stereotactic neurosurgery overview 10.21.2011

8/17/2019 06 Functional Stereotactic Neurosurgery Overview 10.21.2011

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FUNCTIONAL STEREOTACTICNEUROSURGERY OVERVIEW


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FUNCTIONAL STEREOTACTICNEUROSURGERY

• Functional (fŭnk´shŭn-ăl)

Destruction or chronic excitation of a part of the brain totreat disordered behavior or function. Surgery designedto change the function of the nervous system.

• Stereotactic (stĕ!"-#-tăk-t$%) A method in neurosurgery and neurological research for locating points within

the brain using an external, three-dimensional frame of reference usuallybased on the Cartesian coordinate system. "Stereo-" is from the ree! root meaning"three-dimensional and tactile to be "stereotactic", combining the #atin root "to touch"rather than "steroetaxic" from the ree! root for an "arrangement" was accepted asthe o$cial spelling, since surgery involves introducing a probe to the target rather thanmerely de%ning the relationships.

St&&'t%t$% s*&+ ,'ks 'n th& s$s 'f th&& .$n %'./'n&nts0

• A stereotactic atlas of the targeted anatomical structures

• A stereotactic device or apparatus

• A stereotactic locali&ation and placement procedure


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CARTESIAN COOR1INATE SYSTE2

Two-Dimensional Coordinate System• In .th&.t$%s3 th& Cartesian coordinate system $s s&4 t' n$5&l+

4&t&.$n& &%h /'$nt $n th& /ln& th'*h t,' n.&s3 sll+ %ll&4 th& x-coordinate n4 th& y-coordinate 'f th& /'$nt6 T' 4&7n& th& %''4$nt&s3t,' /&/&n4$%l 4$&%t&4 l$n&s (th& x-axis ' abscissa n4 th& y-axis '

ordinate)3 & s/&%$7&43 s ,&ll s th& n$t l&n*th3 ,h$%h $s .k&4 '8 'nth& t,' 9&s (s&& F$*& :)6 Ct&s$n %''4$nt& s+st&.s & ls' s&4 $ns/%& (,h&& th&& %''4$nt&s & s&4) n4 $n h$*h& 4$.&ns$'ns6

Two Dimensional Cartesian coordinate

System. Four points are marked: (2,3) in green,

(-3,1) in red, (-1.5,-2.5) in blue and (0,0), the

origin, in violet.


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Two-Dimensional Coordinate System• Th& $nt&s&%t$'n 'f th& t,' 9&s %&t&s f' &*$'ns3 %ll&4

quadrants3 $n4$%t&4 + th& R'.n n.&ls I3 II3 III3 n4 IV6C'n;&nt$'nll+3 th& 54nts & l&l&4 %'nt&-%l'%k,$s& stt$n*f'. th& n'th&st 54nt6 In th& 7st 54nt3 'th %''4$nt&s

& /'s$t$;&3 $n th& s&%'n4 54nt x -%''4$nt&s & n&*t$;& n4 y -%''4$nt&s /'s$t$;&3 $n th& th$4 54nt 'th %''4$nt&s &n&*t$;& n4 $n th& f'th 54nt3 x -%''4$nt&s & /'s$t$;& n4 y -%''4$nt&s n&*t$;& (s&& tl& &l',6)

Quadrant x-values y-values

I > 0 > 0

II < 0 > 0

III < 0 < 0

IV > 0 < 0

The four quadrants of a Cartesian coordinate system. The

arrows on the axes indicate that they extend forever in their

respective directions (i.e. infinitely).


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• Th&&-4$.&ns$'nl %''4$nt& s+st&. Th& th&& 4$.&ns$'nl %''4$nt& s+st&. /';$4&s th& th&& /h+s$%l4$.&ns$'ns 'f s/%& < h&$*ht3 ,$4th3 n4 l&n*th6 F$*&s &l',3 sh', t,'%'..'n ,+s 'f &/&s&nt$n* th& th&&-4$.&ns$'nl %''4$nt& s+st&.

Three dimensional Cartesian coordinate system with y-

axis pointing away from the observer (Positive)

Three dimensional Cartesian coordinate system with

the x-axis pointing towards the observer (Positive).


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CURRENT FRA2E =ASE1 SYSTE2S


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STEREOTACTIC S>ACE (LOCALI?E1 AREA)


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STEREOTACTIC LOCALI?ATION

1$&%t n4 $n4$&%t t*&t$n*

2RI @ /ls& s&5&n%&s

I.*& Fs$'n

T*&t s&l&%t$'n Ent+ /'$nt n4 t&%t'+ 4&t&.$nt$'n

Indirect and Direct targeting

Indirect targeting - using fixed distances from MCP

Direct targeting – visualization of different anatomical nuclei

on MR images


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I2AGING

Axial CT


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I2AGING

Axial T2T1 Vol


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I2AGING

Image Fusion


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>O>ULAR STEREOTACTIC SYSTE2S

Elekta Leksell Integra Radionics CRW


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CRW FRA2EINTEGRA-RA1IONICS

• A% R4$s :B ..

• F.& %&nt& $s 33 f'D3Y3?

• Cn & $//&4 $n A> 4$&%t$'n• R$*ht3 Ant&$' n4 S/&$'

t' C&nt& ,$ll h;& >'s$t$;&() ;l&s

• L&ft3 >'st&$' n4 Inf&$' t'C&nt& ,$ll h;& N&*t$;& (-);l&s


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LESELL FRA2EELETA

• A% R4$s :H ..

• F.& C&nt& $s :3:3:f' D3Y3?

• F.& %n & s&4 $n Lt&ll&ft ' $*ht %'n7*t$'n

• R$*ht3 >'st&$' n4 S/&$'t' %&nt& ,$ll h;& ;l&s:

• L&ft3 Ant&$' n4 Inf&$' t'%&nt& ,$ll h;& ;l&s J:


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>O>ULAR STEREOTACTIC FRA2ES

• 1$stn%& t' t*&t :H..

• C&nt& 'f f.& $s0:K:K:

• L&ft lt&l ;s R$*ht lt&l

• A4stl& t''l %$&

• S%n .st & 'th'*'nl

Distance to target 160mm

Center of frame is : 0/0/0

No left lateral setting

Fixed tool carrier

Scan does not have to be

orthogonal

Leksell vs. Radionics

Orthogonal?... Relating to or composed of right angles.

Mathematics.

Of or relating to a matrix whose transpose equals its inverse.

Of or relating to a linear transformation that preserves the length of vectors

b. At right angles. The term is used to describe electronic signals that appear at 90 degree angles to each other.

It is also widely used to describe conditions that are contradictory, or opposite, rather than in parallel or in sync

with each other.


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FRA2E A1UST2ENTS

• A4st$n* D3 Y3 ?

Y

Z

! lateral Z ! depth

Y ! anterior"posterior

Z

Y


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FRA2E A1UST2ENT

• A4st$n* F.& f' Ent+ >'$nt

Y

Z

!

lateral

Z !

depth

Y !

anterior"pos

terior

Y

Z

!

lateral

Z !

depth

Y !

anterior"pos

terior

RA= Tan!("#$)

AA= Tan!(%#")

Ring Angle Arc Angle


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FRA2E SETTINGS (CARTESIAN) (CRW)

From 0, Frame Center or MCP

Lateral X Right + (pos)

Left - (neg)

A/P Y Anterior + (pos)

Posterior - (neg)

Vertical Z Superior + (pos)

Inferior - (neg)


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>MANTO2 =ASES

LESELL CRW

06 functional stereotactic neurosurgery overview 10.21.2011

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