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8/17/2019 06 Functional Stereotactic Neurosurgery Overview 10.21.2011
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FUNCTIONAL STEREOTACTICNEUROSURGERY OVERVIEW
8/17/2019 06 Functional Stereotactic Neurosurgery Overview 10.21.2011
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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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CARTESIAN COOR1INATE SYSTE2
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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CARTESIAN COOR1INATE SYSTE2
• 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).
8/17/2019 06 Functional Stereotactic Neurosurgery Overview 10.21.2011
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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
8/17/2019 06 Functional Stereotactic Neurosurgery Overview 10.21.2011
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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