FUNCTIONAL STEREOTACTIC

NEUROSURGERY OVERVIEW

FUNCTIONAL STEREOTACTIC
NEUROSURGERY
Functional (fnkshn-l)
Destruction or chronic excitation of a part of the brain to
treat
disordered behavior or function. Surgery designed
to change the
function of the nervous system.

Stereotactic (str'--tk-tic)
A method in neurosurgery and neurological research for locating points within
the brain
using an external, three-dimensional frame of reference usually
based on the Cartesian coordinate system. "Stereo-" is from the Greek root meaning
"three-dimensional and tactile to be "stereotactic", combining the Latin root "to touch"
rather than "steroetaxic" from the Greek root for an "arrangement" was accepted as
the official spelling, since surgery involves introducing a probe to the target rather than
merely defining the relationships.
Stereotactic surgery works on the basis of three main components:
A stereotactic atlas of the targeted anatomical structures
A stereotactic device or apparatus
A stereotactic localization and placement procedure

CARTESIAN COORDINATE SYSTEM

Two-Dimensional Coordinate System
In mathematics, the Cartesian coordinate system is used to uniquely
determine each point in the plane through two numbers, usually called the
x-coordinate and the y-coordinate of the point. To define the coordinates,
two perpendicular directed lines (the x-axis or abscissa and the y-axis or
ordinate), are specified, as well as the unit length, which is marked off on
the two axes (see Figure 1). Cartesian coordinate systems are also used in
space (where three coordinates are used) and in higher dimensions.

TwoDimensionalCartesiancoordinate
System.Fourpointsaremarked:(2,3)ingreen,
(3,1)inred,(1.5,2.5)inblueand(0,0),the
origin,inviolet.

CARTESIAN COORDINATE SYSTEM

Two-Dimensional Coordinate System
The intersection of the two axes creates four regions, called
quadrants, indicated by the Roman numerals I, II, III, and IV.
Conventionally, the quadrants are labeled counter-clockwise starting
from the northeast quadrant. In the first quadrant, both coordinates
are positive, in the second quadrant x-coordinates are negative and ycoordinates positive, in the third quadrant both coordinates are
negative and in the fourth quadrant, x-coordinates are positive and ycoordinates negative (see table below.)
Quadrant
xvalues
yvalues
I
>0
>0
II
<0
>0
III
<0
<0
IV
>0
<0
The four quadrants of a Cartesian coordinate system. The
arrows on the axes indicate that they extend forever in their
respective directions (i.e. infinitely).

CARTESIAN COORDINATE SYSTEM

Three-dimensional coordinate system
The three dimensional coordinate system provides the three physical
dimensions of space height, width, and length. Figures below, show two
common ways of representing the three-dimensional coordinate system

Three dimensional Cartesian coordinate system with yaxis pointing away from the observer (Positive)

Three dimensional Cartesian coordinate system with

the x-axis pointing towards the observer (Positive).

CURRENT FRAME BASED SYSTEMS

STEREOTACTIC SPACE (LOCALIZED AREA)

STEREOTACTIC LOCALIZATION
Direct and indirect targeting
MRI pulse sequences
Image Fusion
Target selection
Entry point and trajectory determination
IndirectandDirecttargeting
IndirecttargetingusingfixeddistancesfromMCP
Directtargetingvisualizationofdifferentanatomicalnuclei
onMRimages

IMAGING

AxialCT

IMAGING

T1Vol

AxialT2

IMAGING

ImageFusion

POPULAR STEREOTACTIC SYSTEMS

ElektaLeksell

IntegraRadionicsCRW

CRW FRAME
INTEGRA-RADIONICS
Arc Radius 160 mm
Frame center is 0,0,0 for
X,Y,Z
Can be flipped in AP direction
Right, Anterior and Superior
to Center will have Positive
(+) values
Left, Posterior and Inferior to
Center will have Negative (-)
values

LEKSELL FRAME
ELEKTA
Arc Radius 190 mm
Frame Center is 100,100,100
for X,Y,Z
Frame can be used in Lateral
left or right configuration
Right, Posterior and Superior
to center will have values
<100
Left, Anterior and Inferior to
center will have values >100

POPULAR STEREOTACTIC FRAMES

Leksell

vs.

Distance to target 190mm

Center of frame is:
100/100/100
Left lateral vs Right lateral
Adjustable tool carrier
Scan must be orthogonal

Radionics
Distancetotarget160mm
Centerofframeis:0/0/0
Noleftlateralsetting
Fixedtoolcarrier
Scandoesnothavetobe

orthogonal

Orthogonal?...Relatingtoorcomposedofrightangles.
Mathematics.
Oforrelatingtoamatrixwhosetransposeequalsitsinverse.
Oforrelatingtoalineartransformationthatpreservesthelengthofvectors
b. Atrightangles.Thetermisusedtodescribeelectronicsignalsthatappearat90degreeanglestoeachother.
Itisalsowidelyusedtodescribeconditionsthatarecontradictory,oropposite,ratherthaninparallelorinsync
witheachother.

FRAME ADJUSTMENTS
Adjusting X, Y, Z
Z

X
X = lateral

Z = depth

Y
X
Y = anterior/posterior

FRAME ADJUSTMENT
Adjusting a Frame for Entry Point
Ring Angle

Arc Angle

Z
AA= Tan-1(X/Z)

RA= Tan-1(Z/Y)

X=
lateral

Y=
anterior/pos
terior

Z=
depth

X=
lateral

Y=
anterior/pos
terior

Z=
depth

FRAME SETTINGS (CARTESIAN) (CRW)

From0,FrameCenterorMCP
LateralX

Right +(pos)
Left (neg)

A/PY

Anterior+(pos)
Posterior(neg)

VerticalZ

Superior+(pos)
Inferior(neg)

PHANTOM BASES
LEKSELL

CRW