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STEREOTACTIC BRAIN BIOPSY USING ZD FRAME

STEREOTACTIC BRAIN BIOPSY USING ZD FRAME . DR.RAVINDRA SRIVASTAVA , CONSULTANT NEUROSURGEON VIMHANS HOSPITAL.NEW DELHI . DEFINITION.

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STEREOTACTIC BRAIN BIOPSY USING ZD FRAME

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  1. STEREOTACTIC BRAIN BIOPSY USING ZD FRAME DR.RAVINDRA SRIVASTAVA , CONSULTANT NEUROSURGEON VIMHANS HOSPITAL.NEW DELHI

  2. DEFINITION • Stereotactic surgery is a minimally invasive form of surgical intervention which makes use of a three –dimensional coordinates to locate small targets inside the brain and to perform some action on them. • “Stereotactic” in Greek means movement in space.

  3. Historical background • Was first developed by two British scientists in 1908, Sir. Victor Horsley and Robert H.Clarke. • Anatomical points inside the brain as the pineal gland were used as reference. • The method presently uses Image Guided Surgery.

  4. Stereotaxy :Applications • Biopsy, precise tissue sampling with minimal brain damage. • Surgical treatment of Parkinson”s disease by Deep Brain Stimulation. • Brain abscess aspirations. • Tumor resection. • Vascular malformations localisation. • Draining of haematomas. • Functional neurosurgery,suchas epilepsy.

  5. STEREOTAXY : Problems • TIME CONSUMING. • BLIND SURGICAL PROCEDURE. • BRAIN SHIFT REVELANT TO INITIAL REFERENCE POINTS. • INFECTIONS CAUSED BY PIN -HOLES IN THE SKULL. • LACK OF CORRESPONDENCE IN THE COORDINATE SYSTEM OF THE STEREOTACTIC FRAME TO THE PTS. BRAIN COORDINATE SYSTEM.

  6. STEREOTAXY - PROCEDURE • The stereotactic equipmentfor fixation of the patient consists of • - head ring • - fixing posts • - fixing pins

  7. STEREOTAXY -PROCEDURE • The Open Stereotactic System is designed to be used in CT and MRI. • The open ring is made of high-tech ceramics, which gives excellent mechanical stability and MRI compatibilty.

  8. ZD Stereotactic System • The ZD( ZAMORANO/DUCHONVY) center of arc system works from the Cartesian coordinate method for conceptual clarity.

  9. ZD STEREOTAXY SYSTEM • A Cartesian coordinate system specifies each point uniquely in a plane by a pair of numerical coordinates, which are are signed distances from the point to a fixed perpendicular lines measured in the same unit of length.

  10. Stereotaxy Procedure : • Scalp is infiltrated with local anesthesia at four points. • The base ring is then attached to the patients skull with four pins. • The localizing ring is then attached to the base ring.

  11. STEREOTAXY : PROCEDURE

  12. Stereotaxy : Imaging • CT Head is done. • The image obtained in conjunction with the localizing ring allows the neurosurgeon to compute the exact three dimensional position of the region of interest by the intersection of two projections. • The entry point and a line in three dimensional space is calculated by vectorial equation

  13. Stereotaxy: ZD –TM SYSTEM • The patient is brought to the operating room. • The frame is fixed to the operating table with head only slighty elevated above the chest. • A small patch of hair is shaved over the appropriate region. • The ZD-RM Centre of arc system is brought into the target position.

  14. Stereotaxy :Procedure Summary • FIXING THE BASE RING. • LOCALISER FRAME IS FITTED. • CT HEAD DONE. • OBTAINING THE CO-ORDINATES. • VERIFYING THE TARGET. • ARC-LOCALISER FITTED.

  15. OUR EXPERIENCE • I HAVE PERFORMED PERFORMED TWENTY STEREOTACTIC BIOPSIES OVER A PERIOD OF ONE YEAR AT VIMHANS,NEW DELHI.

  16. CONCLUSION • STEREOTAXY IS A SAFE AND MINIMALLY INVASIVE PROCEDURE FOR TAKING BIOPSY FROM DEEP SEATED LESIONS OF BRAIN.

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