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Frameless stereotaxy without rigid pin fixation during awake craniotomies
Eric C Leuthardt1, Douglas Fox, George A Ojemann
1Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Mo., USA.
Stereotactic and Functional Neurosurgery
|August 2, 2003
Summary
This study presents a novel frameless stereotactic technique for awake craniotomy, avoiding pin fixation. The method offers accurate brain tumor resection comparable to traditional methods, enhancing patient comfort.
Area of Science:
- Neurosurgery
- Medical Devices
- Image-Guided Surgery
Background:
- Awake brain mapping combined with frameless stereotaxy improves resection accuracy.
- Traditional frameless stereotaxy often requires Mayfield pin fixation, which can be problematic for awake craniotomy patients.
- An alternative to pin fixation is needed for enhanced patient comfort and safety during awake neurosurgery.
Purpose of the Study:
- To describe and evaluate an alternative method for frameless stereotaxy in awake craniotomy that avoids pin fixation.
- To assess the accuracy and feasibility of this novel technique.
- To compare the outcomes with traditional pin-based stereotactic methods.
Main Methods:
- MRI fiducials were placed near the incision site.
- An epidural skull clamp was attached after craniotomy.
- A spinal reference arc was clamped to the skull clamp, allowing frameless guidance via the Stealth Navigational System.
Main Results:
- The technique was successful in 93% of cases (14 out of 15).
- Accuracy was within 4 mm, with intra-lesional error less than 2 mm.
- Results were comparable to Mayfield pin fixation, with accurate tumor resection assessment.
Conclusions:
- This pinless frameless stereotaxy method avoids complications and discomfort associated with pin fixation.
- The technique allows patient movement without compromising navigational accuracy.
- It provides an efficient, well-tolerated, and accurate navigation method for awake craniotomy patients.