Stereotactic Techniques in Clinical Neurosurgery, Softcover reprint of the original 1st ed. 1986

Various textbooks on stereotactic neurosurgery have been published during the last few years (Riechert 1980, Schaltenbrand and Walker 1982, Spiegel 1982), all of them dealing with functional stereo tactics as the major subject in the field. Diagnostic and therapeutic stereotactic interventions are only briefly described, whereas localization techniques are not yet mentioned. Since 1980, however, an increasing number of reports has been published on CT guided and computer monitored stereotactic performances which enable the surgeon to combine diagnostic and therapeutic efforts in one session. With recent progress in scanning techniques, including high resolution CT, NMR, and PET imaging of the brain, it has become possible to study and localize any brain area of interest. With the concomitant advances in computer technology, 3-dimensional reconstruction of deep seated lesions in stereotactic space is possible and the way is open for combined surgery with stereotactic precision and computer guided open resection. This type of open surgery in stereotactic space is already being developed in some centers with the aid of microsurgical, fiberoptic, and laser beam instrumentation. With these advances stereotactic techniques will rapidly become in­ tegrated into clinical neurosurgery. Stereotactics has become a metho­ dology which enables the surgeon to attack deep seated and subcortical small tumors. Neurosurgeons may abandon therapeutic nihilism, still frequently seen in glioma treatment, in the near future when stereotactic resection will be feasible and remaining tumor cells may be killed by adjuvant treatment modalities still in development.

1: Introduction.- I. Stereotaxy in Experimental Brain Research.- A. Clarke’s Instrument.- B. Clarke’s Idea.- II. Stereotaxy in Man.- A. Functional Stereotactics.- B. Mass Lesions Stereotactics.- C. Stereotactic Localization.- III. Stereotactic Methodology.- IV. Integration of Stereotactics in Clinical Neurosurgery.- 2: Stereotactic Principles.- I. Development.- II. Definition.- III. Stereotactic Atlasses.- IV. Invisible and Visible Targets.- V. Preparation of the Stereotactic Intervention.- A. The Positioning of the Target with X-ray Pictures.- 1. The Invisible Target.- 2. The Visible Target.- B. The Positioning of the Target with Computerized Tomography.- C. Calculation of Target Point.- D. The Stereotactic Intervention.- 1. Talairach System.- 2. Riechert-Mundinger System.- 3. Leksell System.- 4. Todd-Wells System.- 5. The Ideal Stereotactic System.- E. Stereotactically Guided Instruments.- 1. Electrode.- 2. Needle.- 3. Biopsy Instrument.- 4. Catheter.- 5. Electrodes for Permanent Implantation.- 6. Archimedes Screw for Hematoma Evacuation.- 7. Endoscope.- 8. Laser.- F. Spinal Stereotactic Surgery.- 3: Expanding Field of Stereotactic Surgery.- I. Functional Stereotactics.- A. Movement Disorders.- 1. Parkinsonian Tremor.- 2. Essential Tremor.- 3. Cerebellar Dyskinesia.- 4. Torticollis Spastica.- B. Pain Syndromes.- 1. Stereotactic Lesions to Alleviate Pain.- 2. Stereotactic Stimulation with Electrodes to Achieve Pain Relief.- C. Intractable Epilepsy.- D. Psychiatric Disabling Disease.- E. Spasticity.- F. Spinal Stereotactic Procedures.- II. Mass Lesions Stereotactics.- A. Diagnostic Mass Lesions Stereotactics.- B. Therapeutic Mass Lesions Stereotactics.- 1. Aspiration and Evacuation of Fluids.- 2. Interstitial Radioisotope Application.- 3. Stereotactic Radiosurgery.- 4. Coagulation/Resection with Stereotactic Instruments.- 5. Intraneoplastic Drug Delivery with Stereotactic Instruments.- III. Localizing Stereotactics and Open Surgery.- A. Interventional Stereotactics.- B. Localizing Stereotactics.- 4: Modern Instrumentation.- I. Introduction.- II. CT Guided Stereotactic Apparatus; Technical Aspects.- A. Riechert-Mundinger System.- B. Leksell System.- C. Brown-Roberts-Wells System.- D. Other Computed Tomography Based Systems.- 1. CT Based Intracranial Landmark Technique of Gildenberg.- 2. Computerized, CT Guided, Stereotactic System with 3-D Reconstruction of Shelden and Jacques.- 3. Computer Monitored, CT Based, Stereotactic System with 3-D Reconstruction of Kelly and Alker.- III. CT Guided Stereotactic Surgery.- A. General Principles.- B. Advantages over Conventional Stereotactic Surgery.- C. Pitfall.- 5: Indications for Stereotactic Interventions.- I. Indications for Functional Stereotactic Interventions.- A. Movement Disorders.- 1. Parkinsonian Tremor.- 2. Essential Tremor.- 3. Cerebellar Tremor.- 4. Posttraumatic Movement Disorders.- 5. Torsion Dystonia.- 6. Torticollis Spastica.- 7. Hemi-Dystonia.- B. Intractable Pain.- 1. Cancer Pain.- 2. Chronic Intractable Pain.- C. Otherwise Intractable Epilepsy.- D. Psychiatric Disease.- II. Indications for Diagnostic Stereotactic Interventions.- A. Patients Without Previous History of Tumor Who Present a Single Mass Lesion.- B. Patients Without Previous History of Tumor Who Present Multiple Mass Lesions.- C. Patients with a Known Primary Tumor Elsewhere, Who Present a Single Mass Lesion, but Having no Signs of Metastasis Elsewhere in the Body.- D. Patients with a Known Primary Tumor Elsewhere, Who Present Multiple Mass Lesions in the Brain Without Other Metastatic Spread.- III. Indications for Therapeutic Stereotactic Interventions.- A. Evacuation of Fluids.- 1. Cystic Craniopharyngioma.- 2. Cystic Glioma.- 3. Subependymal or Leptomeningeal Cysts.- 4. Colloid Cyst of Third Ventricle.- 5. Brain Abscess.- 6. Primary Hematoma.- B. Interstitial Radioisotope Application.- C. Stereotactic Radiosurgery.- IV. Indications for Localizing Stereotactic Interventions.- A. Small Tumors in the White Matter.- B. Small Subcortical Arteriovenous Malformations.- C. Small White Matter Abscesses.- D. Lobar and Putaminal Hematomas.- E. Subcortical Foreign Bodies.- 6: Contraindications for Stereotactic Interventions.- I. Contraindications for Functional Stereotactic Interventions.- A. Movement Disorders.- B. Chronic Pain Syndromes.- C. Medically Refractory Epilepsy.- D. Psychiatric Disabling Disease.- E. Spasticity.- II. Contraindications for Diagnostic Stereotactic Interventions.- A. Resectable Lesions.- B. Normal Brain Tissue.- C. Intraventricular Tumors.- D. Lower Brainstem Lesions.- E. Vascular Lesions.- F. In or Near the Subarachnoid Space.- III. Contraindications for Therapeutic Stereotactic Interventions.- A. Aspiration and Evacuation of Fluids.- 1. Cystic Craniopharyngioma.- 2. Posttraumatic Hematoma.- B. Interstitial Irradiation of Tumors.- C. Stereotactic Radiosurgery.- IV. Contraindications for Localizing and Interventional Stereotactics.- A. Aneurysms.- B. Deep Seated Arteriovenous Malformations.- C. Foreign Bodies.- 7: Stereotactic Techniques.- I. Leksell’s Apparatus.- II. Preparation of the Patient.- A. Diagnostic and Therapeutic Stereotactics.- B. Functional Stereotactics.- C. Localizing Stereotactics.- III. The Positioning of the Patient.- 8: Pitfalls.- I. Technical Problems.- A. The Superficial Target.- B. Clinical Signs of Increased ICP.- C. Bleeding at the Target Site.- II. Pitfalls by Underlying Pathology.- A. Vascular Lesions.- B. False Positive and False Negative Results.- C. Unsuspected Mass Lesions.- 9: Functional Stereotactics.- I. Extrapyramidal and Cerebellar Tremor.- A. Stereotactic Thalamotomy Prior to L-dopa Institution.- B. Stereotactic Thalamotomy After L-dopa Institution.- II. Intractable Pain Syndromes.- III. Brainstem Stereotactic Surgery in Cancer Pain.- 10: Mass Lesions Stereotactics.- I. Discussion of Deep Seated Tumors According to Growth Pattern.- A. Diffusely Growing Tumors.- B. Butterfly Tumors.- C. Multiple Tumors.- D. Small Deep Seated Tumors.- E. Cystic Tumors.- F. Brainstem Tumors.- G. Pineal Gland Tumors.- H. Skull Base Invading Tumors.- II. Presentation of Our Own Material and Discussion of Other Reports.- 11: Stereotactic Localization with Subsequent Lesion Treatment.- I. Introduction.- II. Colloid Cysts of the Third Ventricle.- III. Primary Deep Seated Hematomas.- A. Hypertensive Intracerebral Hematomas.- B. Primary Brainstem Hematomas.- IV. Deep Seated Small Arteriovenous Malformations.- A. Introduction.- B. Stereotactic Aiming and Open Surgery in Stereotactic Space in Small and Deep Seated AVM’s.- V. Stereotactic Aiming and Open Surgery in Stereotactic Space for Small and Deep Seated Tumors.- 12: Illustrative Cases.- 13: Integration of Stereotactics in Clinical Neurosurgery.- I. Introduction.- II. The Computer in Neurosurgery.- A. The Computer and Functional Stereotactics.- B. The Computer and Diagnostic and Therapeutic Stereotactics.- C. The Computer and Localizing Stereotactics.- 14: Future Possibilities.- I. Introduction of Magnetic Resonance Imaging.- II. Future Applications of Stereotactics in Functional Disorders.- III. Future Applications of Stereotactics in Mass Lesions.- IV. Conclusion.- References.