DR.RAVINDRA SRIVASTAVA ,
CONSULTANT NEUROSURGEON
VIMHANS HOSPITAL.NEW DELHI
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.
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.
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,such as epilepsy.
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.
STEREOTAXY - PROCEDURE
 The stereotactic equipment
for fixation of the patient consists of
 - head ring
 - fixing posts
 - fixing pins
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.
ZD Stereotactic System
 The ZD( ZAMORANO/DUCHONVY) center of
arc system works from the Cartesian coordinate
method for conceptual clarity.
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.
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.
STEREOTAXY : PROCEDURE
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
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.
Stereotaxy :Procedure Summary
 FIXING THE BASE RING.
 LOCALISER FRAME IS FITTED.
 CT HEAD DONE.
 OBTAINING THE CO-ORDINATES.
 VERIFYING THE TARGET.
 ARC-LOCALISER FITTED.
OUR EXPERIENCE
 I HAVE PERFORMED PERFORMED TWENTY
STEREOTACTIC BIOPSIES OVER A PERIOD OF ONE
YEAR AT VIMHANS,NEW DELHI.
CONCLUSION
 STEREOTAXY IS A SAFE AND MINIMALLY
INVASIVE PROCEDURE FOR TAKING BIOPSY FROM
DEEP SEATED LESIONS OF BRAIN.