Frameless Stereotaxy in Children

作者：James M. Drake, Jose Prudencio, Stephanie Holowka, James T. Rutka, Harold J. Hoffman, Robin P. Humphreys · 发表于：Pediatric Neurosurgery · 年份：2008 · DOI：10.1159/000120779 · 被引用次数：67 · 研究领域：Anatomy and Medical Technology、Vascular Malformations Diagnosis and Treatment、Augmented Reality Applications

Frameless stereotaxy provides stereotactic localization without a standard stereotactic frame. Other reference points on the patient are linked to radio-graphic images by means of a three-dimensional (3D) digitizer. We report the use of a frameless stereotactic system to assist in 53 procedures in 52 children using the ISG Viewing Wand system (ISG Technologies, Missasauga, Ont.). This device uses surface landmarks as well as random surface points as the reference system. The three-dimensional digitizer consists of a six-jointed articulated arm to which pointers, a rigid ventriculoscope, or stereotactic biopsy probe guide can be attached. Image reconstruction is performed on standard CT or MRI (3D volume acquisition) images, with typically 3-mm slice thickness. The tip of the probe can be displayed on 3D surfaced objects which can be cut away to reveal reformatted gray scale displayed on the cut surfaces, or in a triorthogonal view where simultaneous reformatted coronal and sagital views at the level of the tip of the probe are displayed. Cases for which the viewing wand was used included craniotomies for tumor (30), vascular malformation (6), epilepsy surgery (5), other lesions (3), rigid ventriculoscopy (9), and stereotactic biopsy (2). The accuracy of the system was measured by placing 20 fiducial markers on a plastic head of which 3-mm thickness CT images had been made. The average error using 4 fiducials as reference points was 1.5 mm when the fiducials were distributed a...