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Frameless stereotaxy: It is all about precision

  • Mostafa M. E. AtteyaEmail author
Technical Notes

Abstract

Background

Modern neurosurgery is nowadays based on technological advances. Intra-operative image guidance systems are frequently utilized in the everyday neurosurgical practice. Frameless stereotactic procedures (FSPs) require a great deal of technical abilities and precautions. Frameless stereotaxy mandates a high degree of problem-solving attitude and on-the-spot neurosurgeon’s creativity.

Objective

In these technical notes, the author aims at presenting his experience in frameless stereotaxy for more than 10 years in the form of easily digestible tricks and pitfalls during every step of FSPs.

Methods

The author retrospectively distilled the tricks and pitfalls of the FSPs performed by him during the past 10 years according to their chronological status in a how-I-do-it fashion.

Results

Chronologically speaking, phases relating to any FSP were divided into five phases: (1) preoperative image acquisition, (2) pre-operative planning, (3) machine setup, positioning, and registration; (4) operative techniques; and (5) post-operative precautions. Faults in any of these phases can result in failure of the procedure or in faulty surgery with subsequent complications. Each stage is addressed in a how I do it fashion, questions and answers, bulleted or numbered tricks and pitfalls, and, in some instances, what-to-do-if scenarios were given.

Conclusion

Frameless stereotaxy is a well-established neurosurgical practice. Many neurosurgeons are only aware with the bare minimum of the technical aspects of frameless stereotaxy and, subsequently, they practice the bare minimum of its applications. FSPs entail a great deal of technical tricks and pitfalls. Awareness of these techniques should be the target of every neurosurgeon.

Keywords

Frameless stereotaxy Stereotaxy Stereotactic Neuronavigation Functional neurosurgery 

Notes

Acknowledgment

I’m deeply indebted to Prof. Dr. Mohamed A. El Beltagy whose knowledge and experience affected me so much. He spared no effort nor time in teaching us what pediatric neurosurgery is.

Compliance with ethical standards

Conflict of interest

The author declares that he has no conflict of interest in personal, financial, institutional, or industry affiliations in any of the drugs, materials, or devices described in this article. The author has no conflicts that may affect ethical adherence.

References

  1. 1.
    Frati A, Pichierri A, Bastianello S, Raco A, Santoro A, Esposito V, Giangaspero F, Salvati M (2011) Frameless stereotactic cerebral biopsy: our experience in 296 cases. Stereotact Funct Neurosurg 89(4):234–245CrossRefGoogle Scholar
  2. 2.
    Bradac O, Steklacova A, Nebrenska K, Vrana J, de Lacy P, Benes V (2017) Accuracy of VarioGuide frameless stereotactic system against frame-based stereotaxy: prospective, randomized, single-center study. World Neurosurg 104:831–840CrossRefGoogle Scholar
  3. 3.
    Verploegh IS, Volovici V, Haitsma IK, Schouten JW, Dirven CM, Kros JM, Dammers R (2015) Contemporary frameless intracranial biopsy techniques: might variation in safety and efficacy be expected? Acta Neurochir (Wien). 157(11):2011–2016.  https://doi.org/10.1007/s00701-015-2543-0 Epub 2015 Aug 29CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Mader MM-D, Rotermund R, Martens T, Westphal M, Matschke J, Abboud T (2019) The role of frameless stereotactic biopsy in contemporary neuro-oncology: molecular specifications and diagnostic yield in biopsied glioma patients. J Neuro-Oncol 141(1):183–194CrossRefGoogle Scholar
  5. 5.
    Malone H, Yang J, Hershman DL, Wright JD, Bruce JN, Neugut AI (2015) Complications following stereotactic needle biopsy of intracranial tumors. World Neurosurg. 84(4):1084–1089.  https://doi.org/10.1016/j.wneu.2015.05.025 Epub 2015 May 22CrossRefPubMedGoogle Scholar
  6. 6.
    Dammers R, Schouten JW, Haitsma IK, Vincent AJPE, Kros JM, Dirven CMF (2010) Towards improving the safety and diagnostic yield of stereotactic biopsy in a single centre. Acta Neurochir 152(11):1915–1921CrossRefGoogle Scholar
  7. 7.
    Lobao CA, Nogueira J, Souto AA, Oliveira JA (2009) Cerebral biopsy: comparison between frame-based stereotaxy and neuronavigation in an oncology center. Arq Neuropsiquiatr. 67(3):876–881.  https://doi.org/10.1590/S0004-282X2009000500018 CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Neurosurgery DepartmentChildren’s Cancer Hospital, Egypt (CCHE-57357)CairoEgypt
  2. 2.Neurosurgery Department, Faculty of MedicineHelwan UniversityHelwanEgypt

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