Fundamentals of Stereotaxy

What is Stereotaxy?
Referencing of unknown volume within a coordinate system

Mathematical Concept that identifies a point in space by its
relationship to 3 planes intersecting at right angles to each
other and intersecting at a common point
X
Axes Introduced Free Volume
X
X
X
Imaging Grid
Quantifies Volume
Treatment Grid
Replaces Imaging Grid
Axes Introduced
Free Volume
X
X
Imaging Grid Treatment Grid
X
Headring = Axis
Localizer = Grid CRW Arc = Treatment Grid
X
Importance of Stereotaxy
Gives us the ability to reach very specific points in the
brain that are close to critical structures without creating
damage to surrounding tissue
Initial interest for Parkinsons Disease Surgery
Extended to applications where accuracy is paramount
biopsy
functional neurosurgery
microsurgery
radiosurgery
History of Stereotaxy
Horsley & Clarke, 1908
Animal Stereotaxy
Stereo - 3 dimensional taxis - arrangement
SPIEGEL & WYCIS
Philadelphia, 1947
Human Stereotactic Apparatus
- tactic to touch
Other Frames...
Lars Leksell, Sweden, 1949
Tallairach, Paris, France 1949
Riechert & Wolff, Freiburg, Germany 1951
Problem with Existing Frames
No Quality Assurance
Stab blindly in the dark
?
BRW (Brown-Roberts-Wells)
USA, 1980
Interlocking Arcs
zero centred
Quality Assurance
AP, LAT, VERT
BRW Phantom Base
CRW (Cosman-Roberts-Wells)
USA, 1988
Arc Centred
CRW Phantom Base
Medical Imaging
Role of Medical Imaging
Increasing interest for Cancer Treatment
Investigation
Diagnosis
Planning
Monitoring Treatment of Malignant Diseases
X-rays
Discovery of X-rays:
Wilhelm Rntgen, Wrzburg, Germany, November
1895
1st Clinical Use:
Needle removed from womans hand using X-rays
Birmingham, UK January 1896
X-rays
X-rays:
Projection of the
attenuating properties
of all the tissue along
the paths of photons
Patient
X-ray source
Receptor
Angiography
X-ray of blood vessels
radio-opaque dye injected and x-rays taken
Computerized Tomography
Conventional X-rays deficient in recognizing
Soft tissue
Depth Information

Needed Method for Taking X-rays on sections
of body
Computerized Tomography
Invention: Radon, 1917
x-ray CT in Clinical Environment:
Hounsfield, British Institute of Radiology Conference,
1972
Computerized Tomography
X-Rays of Section of Body

Rotating X-ray
source 360 ring of
detectors
Magnetic Resonance Imaging
Nuclear Magnetic Resonance (NMR)
discovered independently by 2 sources in 1946
Resonance by Magnetic Field Gradient
discovered in Lauterbur 1973
Put Patient in Magnetic Field & take images of
sections of body
Magnetic Resonance Imaging
Apply Strong Magnetic Field
Magnetic Resonance Imaging
Inject Pulsed Radiofrequency
Magnetic Resonance Imaging
Remove Pulsed Radiofrequency
Magnetic Resonance Imaging
T1 Axial MR Image T2 Axial MR Image
CT vs MR
CT
Good for geometric accuracy
Bad for Morphological Detail
MR
Good for Morphological Detail
Bad for geometric accuracy - distortion
Other Types of Imaging
PET: Positron Emission Tomography

Inject compounds in brain that emit
positronstake scansareas
activated shown in different colours
Other Types of Imaging
SPECT:
Single Photon Emission Computed Tomography

Allows us to see functional information on specific
organs. Inject radioactive isotopes that emit
gamma rays when decaying; these are shown in
the images
Other Types of Imaging
fMRI:
functional Magnetic Resonance Imaging

Allows us to monitor increase of blood flow.
Different activity correspond to different levels of
blood flow. So, monitor the blood flow & you get
the different areas of brain controlling the various
functions.
Other Types of Imaging
fMRI
Image Guided Surgery
Horsley & Clarke
Spiegel & Wycis
Leksell
Tallairach
Riechert & Wolff
BRW
CRW
1908
1980s
Xray
CT
MR
PET/SPECT/fMRI
1876
1980s
Tools to get Images - Ready!
Hardware Precision - Ready!
Computer Technology
Combination?
Catalyst?
Image Guided Surgery
Horsley & Clarke
Spiegel & Wycis
Leksell
Tallairach
Riechert & Wolff
BRW
CRW
1908
1980s
Xray
CT
MR
PET/SPECT/fMRI
1876
1980s
Computer Technology
Image
Guided
Surgery
Image Guided Surgery
Horsley & Clarke
Spiegel & Wycis
Leksell
Tallairach
Riechert & Wolff
BRW
CRW
1908
1980s
Xray
CT
MR
PET/SPECT/fMRI
1876
1980s
Computer Technology

3D Planning
Accurate Targetting
Reduce Damage to Healthy Tissue
More Procedures Operable
Patient Comfort
Image Guided Surgery
Horsley & Clarke
Spiegel & Wycis
Leksell
Tallairach
Riechert & Wolff
BRW
CRW
1908
1980s
Xray
CT
MR
PET/SPECT/fMRI
1876
1980s
Computer Technology
Uses of Framed Stereotaxy
Stereotactic
Radiosurgery/Radiotherapy
Functional Neurosurgery
Parkinsons Disease Surgery
Parkinsons Disease Surgery
Framed to Frameless
Limitations of the frame = uncomfortable for
the patient; cumbersome to work with

Frameless Stereotaxy: Utilizing principles of
stereotaxy without employing rigid frame
Frameless Stereotaxy
Put CT/MR Scans of
Patient in w/s
Co-register Patients
Head to Scans in w/s
Markers Create Volume
in Image Space
Skin Markers
Localizer Quantifies Volume
in Image Space
Localizer
Markers Create Volume
in Image Space
Skin Markers
Register Patient to Image Space
OAS

(Operating Arm System)
1992
OTS

(Optical Tracking System)
1993
Surgical Product Range...
Stereotaxy
Hardware/Software for
Frame Based Stereotaxy
Neurosurgery/Radiotherapy

Image Guided
Hardware/Software for
Frameless Stereotaxy