Stereotaxy Sample Clauses

Stereotaxy. The standard surgical approach is based on the method of frame-based stereotaxy. In this method, a rigid frame is fixed to the patient’s head, using skull pins, to provide a coordinate system. A “stereotactic” MR or CT scan is then performed that shows both the frame axes and the brain structure. The stereotactic coordinates of the brain target to be implanted, with respect to the frame axes, are calculated and the patient is transported to the operating room. Following scalp incision and creation of a xxxx hole in the skull, instruments are mounted on the frame so as to point through the skull opening to the stereotactic target. Electrode insertion is ultimately achieved with this large externalized frame. After scalp closure, and removal of the stereotactic headframe, the patient returns to the scanner for postoperative verification that the electrode is appropriately placed and to exclude early hemorrhage. With this surgical approach, the preoperative stereotactic MR or CT images provide the starting point for the procedure. However, conventional stereotaxy using “historical” (preoperative) images does not by itself provide the required accuracy for final DBS electrode placement. In a conventional operating room setting, there is no intraoperative brain imaging technique that has sufficient contrast and resolution to guide and confirm correct electrode placement. As a result, hours are spent performing physiological “mapping” of the brain with multiple penetrations of a microelectrode so as to determine the correct target location based on brain electrical activity in the region of the intended target. This micro-electrode recording (MER) technique is used to map the borders of the target nucleus with greater spatial resolution than is possible with stereotaxy alone (19). The final electrode location may be up to 3 mm away from the initial stereotactic target, based on the correction afforded by intraoperative microelectrode exploration. MER methods are well established for STN DBS in Xxxxxxxxx’x disease, but are much less well established for dystonia. Physiological mapping inherently requires the patient to be awake during surgery and off their usual medications.
Sample 1
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