Expandable grid, a simple, readily available and precise technique for intraoperative stereotactic real-time imaging

Area of Science:

• Neurosurgery
• Medical Imaging
• Stereotactic Procedures

Background:

• Intraoperative imaging like CT and MRI is crucial for stereotactic procedures but not universally available.
• Microelectrode recording (MER) is also limited to select centers.
• This study proposes fluoroscopy as an accessible alternative for intraoperative control.

Purpose of the Study:

• To introduce and validate a novel fluoroscopy-based technique for stereotactic target planning and coordinate validation.
• To demonstrate the accessibility and accuracy of this method compared to existing modalities.

Main Methods:

• Adapted the Riechert Mundinger (RM) and Zamorano-Dujovny (ZD) stereotactic systems by shifting the Z-value zero point.
• Utilized radiopaque markers and Angio/X-ray localizing plates to create an orthogonal, non-distorted stereotactic space.
• Superimposed magnified millimetric grids on fluoroscopic images for precise coordinate validation in AP and lateral views.

Main Results:

• The technique was validated using phantom conditions and intraoperative fluoroscopic images.
• Results demonstrated high accuracy, with a margin of error below 1 mm.
• The method proved comparable in accuracy to more complex imaging techniques.

Conclusions:

• The developed fluoroscopy technique is accurate, accessible, mobile, and manageable for intraoperative stereotactic guidance.
• It offers immediate access to stereotactic coordinates, enhancing surgical planning and execution.
• This approach provides a cost-effective and efficient alternative to advanced imaging modalities.