Brain Stereotactic Technique for Minimally Invasive Neurosurgery

  Human spatial sense is an advanced sense and an ability. It is not like hearing, seeing, smelling, etc. which are just general senses with dedicated functional areas in the brain, but spatial sense is a sense done by several brain areas together and is a whole function of the brain. Therefore, human spatial orientation ability generally needs some kind of tool to assist, and stereotactic techniques of the brain are even more difficult, and tools and equipment are needed to improve brain surgeons’ stereotactic techniques of brain tissue.  When it comes to stereo, people tend to think of one-sidedness. A psychologist once gave a quiz in which four trees were planted on a piece of land, so that the distance between each two trees was equal. The students drew one geometric figure after another on the paper: square, rhombus, trapezoid, parallelogram …… However, no matter what quadrilateral did not work. At this point, the psychologist announced the answer, one of the trees could be planted on top of the hill! Thus, if the remaining three trees form a square tetrahedron with it, it will meet the requirements of the question. This example reminds people to think outside the limits of points, lines and surfaces and to think in three dimensions. For brain surgeons, who are in orientation and orientation every day, it is from the original point, surface and line orientation slowly developed to three-dimensional orientation.  Brain stereotactic technology has been proposed for more than 100 years, from experiments, instrumentation finalization to clinical application has gone through a long time.  The traditional practice of orientation surgery is a pair of orientation frames, an x-ray, a piece of paper and a pen. Those early “techniques” of directional surgery have evolved to the advanced Image Guided Surgery (or IGS), which is frameless and consists of neuroimaging, computers and their tools. It is a combination of neuroimaging, computer and software technology and microscopic neurosurgery, and it is becoming an essential surgical technique for a wide range of neurosurgeons. It can be said that the history of brain stereotactic techniques is divided into two main phases: in 1908 Horsley and Clarke founded three-dimensional brain stereotactic techniques, in 1945 Spiegel and Wycis completed the first ever human brain stereotactic surgery, the second breakthrough in the history of brain stereotactics occurred in 1979, Brown invented the use of positioning frames with CT The second breakthrough in the history of brain stereotaxy occurred in 1979, when Brown invented the use of a positioning frame aligned with CT scanning for non-functional diseases of the nervous system. The first high-precision brain stereotactic instrument that can be connected with CT or MR was put into clinical use in China in 1993 by Shenzhen Anke High Technology Co.  The organic combination of imaging, radiosurgery and stereotactic technology has resulted in a variety of new treatment tools, such as cerebral angiography, magnetic resonance stereotactics, Doppler-assisted stereotactics, endoscopic stereotactics, PET-assisted brain stereotactics, etc. The introduction and development of the concept of stereotactic radiosurgery, the application of gamma knife, X-blade and proton beam radiation system have further deepened the concept of minimally invasive or non-invasive. There are framed brain stereotactic neurosurgery is one of the aspects.  1, brain stereotactic instrument: to stereotactic need to have a three-dimensional spatial coordinate system, framed brain stereotactic is artificially installed outside the skull a frame, by it to form a three-dimensional spatial coordinate system, so that the brain structure included in this coordinate system, then the frame and the patient together with CT or MRI scan, will get with the frame coordinates of the patient’s cranial CT or MRI parameters marked The images of the patient’s cranial anatomy will have a corresponding coordinate value in this coordinate system, and then the mechanical data defined by the brain stereotactic instrument will be used to reach the coordinate point, so as to realize the brain stereotactic.  At present, domestic and foreign production of brain stereotactic instrument not only high positioning accuracy (less than 1mm), and easy to use, and can be matched with X ray, CT, MRI. Foreign good orientation instrument: Leksell orientation system, BRW/CRW orientation system, Todd-well orientation system, etc.; domestic have Shenzhen Anke high technology limited company’s ASA-601, 602 orientation instrument, etc.  2, stereotactic atlas: brain stereotactic instrument is to establish a coordinate system through the framework outside the skull, stereotactic atlas is the use of intracerebral signs for the establishment of the coordinate system to locate. Clinically, it is used to determine the position of each nucleus by using the pre-connectivity and post-connectivity as markers. Generally, three reference planes and three reference axes are defined on the brain, i.e., the line from the midpoint of the posterior border of the anterior conjunction to the midpoint of the anterior border of the posterior conjunction is called the interconnection path, the horizontal plane made through it is called the HO plane, the coronal plane through the interconnection path is called the FO plane, and the median sagittal plane of the brain, the SO plane, constitute the three reference planes.  The intersection of these three reference planes is called the origin (O point), and the coordinate value is 0. The axis in the front and back direction through the origin is the sagittal axis (coincident with the conjoined interpath) and is designated as the Y axis; the vertical axis perpendicular to the Y axis in the up and down direction through the origin is designated as the Z axis; and the coronal axis intersecting with the left and right direction through the origin and perpendicular to the Y axis is designated as the X axis. The above X, Y and Z axes are the three reference axes. Applying these planes and axes, the three-dimensional spatial coordinates of each structure in the brain can be traced.  3, the clinical application of brain stereotactic technology; (1) intracranial hematoma directional evacuation: since 1978 Beck lund first successfully designed stereotactic hematoma evacuation device, and obtain the success of the application.  (2) Movement disorders: the application of brain stereotactic techniques to perform destruction of the corresponding nuclei.  (3) Chronic pain: destruction of the cingulate gyrus at the level of the brain, destruction of the posterior ventral nucleus and central nucleus at the level of the thalamus, etc.  (4) Epilepsy: generalized primary epilepsy, temporal lobe epilepsy with aggressive behavior or those who cannot be resected for typical lesions, can choose stereotactic techniques to destroy the epileptic lesions or block the intermediate loops of seizure-issuing impulses, such as amygdala, Forel-H, posterior hypothalamus, and certain nuclei in the thalamus.  (5) Psychosis: targeted destruction of certain nuclei in the limbic system, forebrain, with proven efficacy.  (6) Brain tumors: Stereotactic techniques have been widely used for targeted biopsies, and then combined with stereotactic radiosurgery and stereotactic microsurgery to completely destroy or excise tumors for therapeutic purposes.