Image guided surgery (IGS) is a bro...

Image guided surgery (IGS) is a broad bourn referring to a number of radiographic modalities used in anatomic localization proceedings One of the most novel modalities is a technology called frameless stereotaxy--a bound originating from the technology's initial use in cranial neurosurgical manner of proceedings Frameless stereotactic IGS provides a recent way to navigate three dimensionally without having to soar a frame to the patient's head. Many manufacturers yield this equipment, which is seen widely from head to foot neurosurgical ORs. Now this technology is broadening, and recent applications in other areas and specialties are being implemented.

BACKGROUND

The idea of navigating three dimensionally in the brain-pan has been around since the beginning of the hundred years The objective was to unravel a method to define a specific point within the three-dimensional space of the cranium. At this time, the bourn stereotactus--based on the Greek word stereo meaning three dimensional, and the Latin word tactus, meaning touch--was introduced.(1)

Framed stereotaxy. The first attempt to unravel this method was the construction of a stereotactic frame in the early 1900s(2) This technique--which was not actually touchstoneed on a human until the 1940s--worked by dint of mounting the stereotactic frame to a patient's head using the exterior auditory canals and the inferior orbital rims as landmarks.(3) With these landmarks at hand on plain x-rays, neurosurgeons could calculate desired intracranial locations. This technique ultimately was abandoned because of the inability to calculate accurate adjustments when a patient's brain tissue had been shifted because of lesions.(4)

late advances. Stereotactic surgery was not practiced for many decades until the 1980 when advances occurr in comput tomography (CT) and magnetic resonance imaging (MRI).(5) These radiographic modalities provided the ability to view abnormal shifting of the brain and determine a desired three-dimensional location in the cranium. Stereotactic neurosurgery quickly became Standard practice for assisting in lesion resections and collecting profound brain tissue for biopsy. This was a big degree for neurosurgery, providing surgeons with greater confidence and patients with better issues and quicker recoveries.

Frameless stereotaxy. With continued advances in computer technology, the idea of frameless navigation perform the operations indicated ined The first neurosurgical procedure using a frameless technique was performed in the early 1980s(6) Since then, many frameless a whole s have been manufactured, and clinical trials for cranial surgery by means of the US Food and mix with drugs Administration (FDA) have been complet and approved. The FDA nearest explored and approved a strange application of the frameless technique in spinal surgery which enabled surgeon not and nothing else to navigate to specific points however also to determine trajectories in the anatomy. This prov to be extremely useful for determining angle, longitudinal dimensions and width of hardware placement. It is now usual practice across the United States to use frameless stereotaxy for the couple cranial and spinal neurosurgical procedures

FRAMELESS STEREOTAXY ADVANTAGES

Frameless stereotaxy in cranial and spinal manner of proceedings has many advantages over traditional rules for surgeons and, more importantly, for patients. Advantages for cranial conducts include

* real-time interaction with MRI images, allowing more precise surgical planning;

* smaller incisions and craniotomies;

* les invasive excisions, which may improve patient outcomes;

* les restriction of surgical access because of lack of stereotactic frame;

* les patient discomfort from having to wear a stereotactic frame to and from the CT or MRI unit and OR;

* les preparation time than framed stereotaxy because the frame does not ne to be applied to the patient and calculations do not ne to be made in the CT or MRI unit;

* easier use with pediatric patients, as les cooperation is needed(7)

Advantages for spinal steps include

* reduction and possible elimination of intraoperative radiation exposure;

* improvement of hardware placement accuracy, providing better patient outcomes;

* easier rules for surgical planning (eg, determining force length and width for a particular vertebra preoperatively);

* reduction in surgical management time by making hardware placement decisions more efficient.

arrangement COMPONENTS

Although today several manufacturers bring forth different frameless stereotactic systems, the project and functions of the regularitys basically are the same. The main variations in the regularitys involve software and tools. most numerous systems have two separate pieces that can be whirled into the OR (ie, a cart, which houses the composings and a camera, which is soared on a separate boom) (Figure 1) All frameless stereotactic combination of parts to form a wholes include the following components:

[Figure 1 ILLUSTRATION OMITTED]

* a high-power computer that has the ability to instantly store and proces MRI or CT images to provide real-time feedback;