The development of a mechanical analog for directing and tracking the electrode during stereotaxic operations. Technical note.
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Stereotaxic biopsy of cerebral tumors has been considerably facilitated by the use of CT scanner. A new method is described using the CT section in the horizontal or oblique plan of biopsy. When this has been determined, it is possible to define a trajectory, calculated by the CT scan computer, with external landmarks marked on the skin. This method is possible with any kind of CT apparatus; the surgical biopsy is performed in the operating room with a simple stereotaxic frame square-shaped and fixed in the plan of the CT section. The biopsy needle may be oriented in an antero-posterior or medio-lateral direction. This method has been used in 33 patients, leading to as precise histological diagnosis in 30 cases. No complications have been noted, except for transient neurological deterioration in two cases, due to local edema. Hemorrhage have not been observed. The topographical precision of the method was verified by the injection of lcc of air followed by a post-biopsy CT scan. This technique seems particularly valuable for the diagnosis of deep or wide spread hemispheric tumors, non indicated for open surgery.
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One potential source of computerized tomography image artifact during stereotaxic data acquisition is scatter from standard steel-tipped fixation pins as supplied for use with the Brown-Roberts-Wells stereotaxic headframe. In some cases, this can hinder selection of periventricular targets. Replacement of the steel-tipped pins with aluminum-tipped pins, which produce less artifact, helps to facilitate stereotaxic intervention.
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In order to study the actions of certain substances at cerebral level, a stereotactic device for ensuring a precise catheterization of points in certain cerebral areas was used. For the operation technique was used a stereotaxic atlas specifically designed for rat brain (G. Paxinos, C. Watson, 1998), which offers all the necessary information for the identification of the trepanation. Stereotaxic implantation of cannules in the brain is useful for microinjecting solutions containing various substances (in amounts of microl), directly and targeted in the anatomical structures of the brain. The technique described can use either metalic or silastic cannules, that have variable lumen (usually for adapting a Hamilton syringe). The cannules can be implanted at cerebroventricular level, having the possibility to target all the cerebral ventricles. The intracerebroventricular (icv) administration of L-arginine induces a significant increase of response latency for mechano-algesic test. The most obvious changes are induced following the administration of the association of L-NAME with L-arginine, situation when is manifested an important increase of the response latency, starting with 5 minutes post-administration and continuing up to 45 minutes determination. The increase is significantly higher compared with the results obtained with L-arginine alone. A similar evolution is registered in the case of the plantar test.
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A special stereotaxic device is described which was conceived and built to integrate the peculiar orthogonal approach of the well known Talairach apparatus with a polar approach. The device is useful to reach small and deep-seated brain targets, particularly those located on or close to the midline. Its use in several different stereotaxic operations, such as thalamotomy, brain-tumor biopsy, or radiotherapy, proved its flexibility, safety, and reliability.
A stereotaxic device is described for percutaneous twist-drill insertion of depth electrodes for seizure recording and brain biopsy. This apparatus, which permits a lateral orthogonal approach, has been used in conjunction with a Leksell type of stereotaxic frame. Its main advantages are the ample working space it provides at the site of insertion of intracerebral electrodes, and the stable attachment it offers in fixing these electrodes on the skull.