Stereotaxis

The stereotatic technique enables operations on deep brain structures with minimal tissue damage in the approach path.

• They are puncture procedures performed with a targeted trepanation drill bit with high targeting accuracy.
• They are used either in functional neurosuregery (affecting dyskinesia) or as a puncture biopsy, evacuation of cysts, abscessses, etc.
• For orientation, the patient has a stereotaxic device fixed on is head.

Functional operations

Biopsie mozku pod stereotaktickou kontrolou

• The target structures are deep structures in the brain (nuclei of the thalamus , BG , etc.).
• Aiming is done using reference points in the vicinity III. ventricles (anterior commisure and psterior commissure) – shown by MRI or ventriculography .
• The procedure itself is the targeted destruction of the tissue of a defined volume, most often we do it with a high-frequency current or gamma radiation ( LGK ).
• Procedures are performed under LA (local anesthesia), due to contact with the patient - the possibility of clinical and EEG monitoring.
• Two phases:
  1. after deploying the device, we aim at te points according to the MRI, determine the target point;
  2. we make a trepanation drill bit and introduce the probe using the guidance device.

• the stereotatic frame is made of special materials so as not to interfere with imaging techniques

Indication

• The most common are various forms of dysinesia.
• Often in Parkinson's disease - in the case of pharmacologically uncontrolled tremor , which also affects rigidity, coagulation lesions are made in the nuclei of the thalamus, in the subthalamus and in the pallidum .
• Other controllable dyskinesias – chorea , athetosis , hemiballismus .
• In children with severe forms of DMO ,dentate nucleus is destroyed of the cerebellum → we reduce muscle hypertonus .
• Less common indications:
  • chronic pain (nonspecific thalamic nuclei);
  • psychoses – bilateral gyrus cinguli coagulation.
• Sometimes we can implant electrodes and stimulate long-term.

Links

Sources

• BENEŠ, Jiří. Studijní materiály [online]. ©2007. [cit. 2010]. <http://www.jirben.wz.cz/>.

Reference

• ZEMAN, Miroslav. Speciální chirurgie. 2. edition. Prague : Galen, 2004. 575 pp. ISBN 80-7262-260-9.

Category:Neurosurgery Category:Neurology