[Frame-less and frame-based stereotaxy? How to choose the appropriate procedure]

Area of Science:

• Neurosurgery
• Medical Imaging
• Surgical Technology

Background:

• Advancements in image-guided surgery have introduced frameless stereotaxy tools for procedures like intracerebral lesion puncture and biopsy.
• The indications for frameless and frame-based stereotaxy systems are increasingly overlapping, necessitating a clear understanding of their respective strengths.
• Image-guided surgery provides essential continuous 3-dimensional topographical orientation during neurosurgical interventions.

Purpose of the Study:

• To analyze key factors influencing the decision between using frameless and frame-based stereotaxy.
• To compare the application accuracy, image information, and ergonomics of both stereotactic systems for various lesion types.

Main Methods:

• Comparative analysis of frameless and frame-based stereotactic systems.
• Investigation of criteria including application accuracy, image quality (e.g., 1 mm slice thickness), and ergonomics.
• Evaluation of patient registration methods: bone marker versus adhesive skin fiducials.

Main Results:

• Frameless stereotaxy with high-quality imaging and bone marker registration can achieve accuracy comparable to frame-based systems.
• Frameless stereotaxy using adhesive skin fiducials demonstrates lower accuracy than frame-based systems.
• Lesion size is a critical factor: frameless systems are suitable for lesions >10 mm, whereas frame-based systems are superior for lesions <10 mm.

Conclusions:

• Frameless and frame-based stereotaxy are complementary, each with distinct indications in image-guided surgery.
• Frame-based stereotaxy remains the gold standard for precise targeting of small lesions (<10 mm) and functional neurosurgical procedures.
• The choice between systems depends on lesion characteristics, required accuracy, and registration method.