Flexibility of Head Positioning and Head Fixation Provided by a Novel System for Non-invasive Maxillary Fixation and Frameless Stereotaxy: Technical Note

Abstract

Objective: The aim of this study was to demonstrate the flexibility in patient positioning and head fixation provided by a newly developed, minimally invasive upper jaw fixation device in combination with standard navigation software.

Technique: The Vogele-Bale-Hohner (VBH) headholder and the Stereotactic Intervention and Planning Laboratory (SIP-Lab) Innsbruck reference frame, were applied in epilepsy surgery requiring stereotactic guidance. The system can be adapted to various positioning and instrument guidance requirements. Instrument holders can be fixed either to a base plate or directly to the mouthpiece. When used together with a head clamp and a stabilizing arm, there are no restrictions on patient positioning. When used with the non-invasive headholder, only the supine position is well-suited for use with the described guidance instrumentation. The system can also be used with the head placed on the horseshoe headholder without altering navigation support.

Conclusion: The VBH mouthpiece combined with an external registration frame is a flexible tool that permits patient positioning and neuronavigation with the head either fixed with a head clamp, or restrained non-invasively with a headholder, or not fixed at all. This might be advantageous within the context of epilepsy surgery.

computer-aided surgery - frameless stereotaxy - navigation system - VBH headholder

References

• 1 Alp MS, Dujovny M, Misra M. et al . Head registration techniques for image-guided surgery.  Neurol Res. 1998;  20 31-37
• 2 Bale RJ, Vogele M, Freysinger W. et al . A minimally invasive headholder to improve the performance of frameless stereotactic surgery.  Laryngoscope. 1997;  107 373-377
• 3 Martin A, Bale RJ, Vogele M. et al . Vogele-Bale-Hohner mouthpiece: registration device for frameless stereotactic surgery.  Radiology. 1998;  208 261-265
• 4 Bale RJ, Burtscher J, Eisner W. et al . Computer-assisted neurosurgery by using a noninvasive vacuum-affixed dental cast that acts as a reference base: another step toward a unified approach in the treatment of brain tumors.  J Neurosurg. 2000;  93 208-213
• 5 Lightstone AW, Benedict SH, Bova FJ. et al . Intracranial stereotactic positioning systems: Report of the American Association of Physicists in Medicine Radiation Therapy Committee Task Group No. 68.  Med Phys. 2005;  32 2380-2398
• 6 Burtscher J, Sweeney R, Bale RJ. et al . Neuroendoscopy based on computer-assisted adjustment of the endoscope holder in the laboratory.  Minim Invas Neurosurg. 2003;  46 208-214
• 7 Baerts WDM, Lange JJ De, Booij LH. et al . Complications of the Mayfield skull clamp.  Anesthesiology. 1984;  61 460-461
• 8 Garfin SR, Botte MJ, Centeno RS. et al . Osteology of the skull as it affects halo pin placement.  Spine. 1985;  10 696-698
• 9 Barazi SA, Cudlip S, Marsh H. Awake craniotomy using stealth frameless stereotaxy without rigid skull fixation.  Brit J Neurosurg. 2006;  20 43-45
• 10 Suess O, Picht T, Kuehn B. et al . Neuronavigation without rigid pin fixation of the head in left frontotemporal tumor surgery with intraoperative speech mapping.  Neurosurgery. 2007;  60 ((ONS Suppl. 2)) ONS330-338
• 11 Greenberg IM. Self-retaining retractors and handrests. In: Wilkins RH, Rengachary SS, eds. Neurosurgery, Second edition. McGraw-Hill, New York 1996: 595-605
• 12 Heifez MD. Use and misuse of instruments. In: Apuzzo MLJ, ed. Brain Surgery, Volume 1. Churchill Livingstone, New York 1993: 71-90

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