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

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

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.

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