Stereotaxis: Difference between revisions
From WikiLectures
No edit summary |
No edit summary |
||
| Line 7: | Line 7: | ||
[[Image:Brain biopsy under stereotaxy.jpg|thumb|right|Biopsie mozku pod stereotaktickou kontrolou]] | [[Image:Brain biopsy under stereotaxy.jpg|thumb|right|Biopsie mozku pod stereotaktickou kontrolou]] | ||
* The target structures are deep structures in the brain (nuclei of the [[thalamus]] , [[Basal ganglia|BG]] , etc.). | * The target structures are deep structures in the brain (nuclei of the [[thalamus]] , [[Basal ganglia|BG]] , etc.). | ||
* Aiming is done using reference points in the vicinity III. ventricles (anterior commisure and | * Aiming is done using reference points in the vicinity III. ventricles (anterior commisure and posterior 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 ( [[Leskell gamma knife|LGK]] ). | * 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 ( [[Leskell gamma knife|LGK]] ). | ||
* Procedures are performed under [[Local anesthesia|LA]] (local anesthesia), due to contact with the patient - the possibility of clinical and [[EEG]] monitoring. | * Procedures are performed under [[Local anesthesia|LA]] (local anesthesia), due to contact with the patient - the possibility of clinical and [[EEG]] monitoring. | ||
* Two phases: | * Two phases: | ||
*# after deploying the device, we aim at | *# after deploying the device, we aim at the points according to the MRI, determine the target point; | ||
*# we make a trepanation drill bit and introduce the probe using the guidance device. | *# we make a trepanation drill bit and introduce the probe using the guidance device. | ||
| Line 23: | Line 23: | ||
* Less common indications: | * Less common indications: | ||
** chronic [[pain]] (nonspecific thalamic nuclei); | ** chronic [[pain]] (nonspecific thalamic nuclei); | ||
** [[psychoses]] – bilateral gyrus | ** [[psychoses]] – bilateral cingulate gyrus coagulation. | ||
* Sometimes we can implant electrodes and stimulate long-term. | * Sometimes we can implant electrodes and stimulate long-term. | ||
Revision as of 15:53, 22 December 2022
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
- 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 posterior 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:
- after deploying the device, we aim at the points according to the MRI, determine the target point;
- 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:
- 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.
