N-localizer

The N-localizer[3] or N-bar is a device that enables guidance of stereotactic surgery or radiosurgery using tomographic images that are obtained via computed tomography (CT),[4] magnetic resonance imaging (MRI),[5] or positron emission tomography (PET).[6] The N-localizer comprises a diagonal rod that spans two vertical rods to form an N-shape (Figure 1) and permits calculation of the point where a tomographic image plane intersects the diagonal rod. Attaching three N-localizers to a stereotactic instrument allows calculation of three points where a tomographic image plane intersects three diagonal rods (Figure 2). These points determine the spatial orientation of the tomographic image plane relative to the stereotactic frame.[7]

N-localizer
Three N-localizers attached to a stereotactic frame.[1]
Specialtyneurosurgery, radiation oncology
Interventionstereotactic surgery, radiosurgery
Inventor(s)Russell A. Brown[2]

The N-localizer is integrated with the Brown-Roberts-Wells (BRW),[8] Kelly-Goerss,[9] Leksell,[10] Cosman-Roberts-Wells (CRW),[11] Micromar-ETM03B, FiMe-BlueFrame, Macom, and Adeor-Zeppelin[12] stereotactic frames and with the Gamma Knife radiosurgery system.[13]

An alternative to the N-localizer is the Sturm-Pastyr localizer or V-bar that comprises three rods wherein two diagonal rods form a V-shape and a third, vertical rod is positioned midway between the two diagonal rods (Figure 3).[14] The Sturm-Pastyr localizer is integrated with the Riechert-Mundinger and Zamorano-Dujovny stereotactic frames.[15]

Compared to the N-localizer, the Sturm-Pastyr localizer is less accurate and necessitates more elaborate calculations to determine the spatial orientation of the tomographic image plane relative to the stereotactic frame.[16] In contrast to the N-localizer that does not require specification of the pixel size in a tomographic image,[17] the Sturm-Pastyr localizer requires precise specification of the pixel size.[18]

Figures

References

  1. Arle, J (2009). "Development of a Classic: The Todd-Wells Apparatus, the BRW, and the CRW Stereotactic Frames". In Lozano, AM; Gildenberg, PL; Tasker, RR (eds.). Textbook of Stereotactic and Functional Neurosurgery. Berlin: Springer-Verlag. pp. 456–460. doi:10.1007/978-3-540-69960-6. ISBN 978-3-540-69959-0. S2CID 58803140.
  2. "System Using Computed Tomography as for Selective Body Treatment". U.S. Patent 4608977. 1986.
  3. Galloway, RL Jr. (2015). "Introduction and Historical Perspectives on Image-Guided Surgery". In Golby, AJ (ed.). Image-Guided Neurosurgery. Amsterdam: Elsevier. pp. 2–4. doi:10.1016/B978-0-12-800870-6.00001-7. ISBN 978-0-12-800870-6.
  4. Thomas DG, Anderson RE, du Boulay GH (1984). "CT-guided stereotactic neurosurgery: experience in 24 cases with a new stereotactic system". Journal of Neurology, Neurosurgery & Psychiatry. 47 (1): 9–16. doi:10.1136/jnnp.47.1.9. PMC 1027634. PMID 6363629.
  5. Heilbrun MP, Sunderland PM, McDonald PR, Wells TH Jr, Cosman E, Ganz E (1987). "Brown-Roberts-Wells stereotactic frame modifications to accomplish magnetic resonance imaging guidance in three planes". Applied Neurophysiology. 50 (1–6): 143–152. doi:10.1159/000100700. PMID 3329837.
  6. Maciunas RJ, Kessler RM, Maurer C, Mandava V, Watt G, Smith G (1992). "Positron emission tomography imaging-directed stereotactic neurosurgery". Stereotactic and Functional Neurosurgery. 58 (1–4): 134–140. doi:10.1159/000098986. PMID 1439330.
  7. Gildenberg, PL; Krauss, JK (2009). "History of Stereotactic Surgery". In Lozano, AM; Gildenberg, PL; Tasker, RR (eds.). Textbook of Stereotactic and Functional Neurosurgery. Berlin: Springer-Verlag. p. 23. doi:10.1007/978-3-540-69960-6. ISBN 978-3-540-69959-0. S2CID 58803140.
  8. Heilbrun MP, Roberts TS, Apuzzo ML, Wells TH, Sabshin JK (1983). "Preliminary experience with Brown-Roberts-Wells (BRW) computerized tomography stereotaxic guidance system". Journal of Neurosurgery. 59 (2): 217–222. doi:10.3171/jns.1983.59.2.0217. PMID 6345727.
  9. Goerss S, Kelly PJ, Kall B, Alker GJ Jr (1982). "A computed tomography stereotactic adaptation system". Neurosurgery. 10 (3): 375–379. doi:10.1227/00006123-198203000-00014. PMID 7041006.
  10. Leksell L, Leksell D, Schwebel J (1985). "Stereotaxis and nuclear magnetic resonance". Journal of Neurology, Neurosurgery & Psychiatry. 48 (1): 14–18. doi:10.1136/jnnp.48.1.14. PMC 1028176. PMID 3882889.
  11. Couldwell WT, Apuzzo ML (1990). "Initial experience related to the Cosman-Roberts-Wells stereotactic instrument. Technical note". Journal of Neurosurgery. 72 (1): 145–8. doi:10.3171/jns.1990.72.1.0145. PMID 2403588. S2CID 1363168.
  12. Sedrak M, Alaminos-Bouza AL, Srivastava S (2020). "Coordinate systems for navigating stereotactic space: how not to get lost". Cureus. 12 (6): e8578. doi:10.7759/cureus.8578. PMID 32670714.
  13. Tse, VCK; Kalani, MYS; Adler, JR (2015). "Techniques of Stereotactic Localization". In Chin, LS; Regine, WF (eds.). Principles and Practice of Stereotactic Radiosurgery. New York: Springer. pp. 25–32. doi:10.1007/978-1-4614-8363-2. ISBN 978-1-4614-8362-5.
  14. Sturm V, Pastyr O, Schlegel W, Scharfenberg H, Zabel HJ, Netzeband G, Schabbert S, Berberich W (1983). "Stereotactic computer tomography with a modified Riechert-Mundinger device as the basis for integrated stereotactic neuroradiological investigations". Acta Neurochirurgica. 68 (1–2): 11–17. doi:10.1007/BF01406197. PMID 6344559. S2CID 38864553.
  15. Krauss, JK (2009). "The Riechert/Mundinger Stereotactic Apparatus". In Lozano, AM; Gildenberg, PL; Tasker, RR (eds.). Textbook of Stereotactic and Functional Neurosurgery. Berlin: Springer-Verlag. pp. 487–493. doi:10.1007/978-3-540-69960-6. ISBN 978-3-540-69959-0. S2CID 58803140.
  16. Alaminos-Bouza AL, Brown RA (2020). "Comparative accuracies of the N-localizer and Sturm-Pastyr localizer in the presence of image noise". Cureus. 12 (7): e9137. doi:10.7759/cureus.9137. PMID 32685325.CS1 maint: uses authors parameter (link)
  17. Weaver K, Smith V, Lewis JD, Lulu B, Barnett CM, Leibel SA, Gutin P, Larson D, Phillips T (1990). "A CT-based computerized treatment planning system for I-125 stereotactic brain implants". International Journal of Radiation Oncology, Biology, Physics. 18 (2): 445–454. doi:10.1016/0360-3016(90)90114-Y. PMID 2406230.
  18. Dai J, Zhu Y, Qu H, Hu Y (2001). "An algorithm for stereotactic localization by computed tomography or magnetic resonance imaging". Physics in Medicine and Biology. 46 (1): N1–N7. doi:10.1088/0031-9155/46/1/401. PMID 11197682. S2CID 9196917.

Further reading

  • Saleh, H; Kassas, B (2014). "Developing Stereotactic Frames for Cranial Treatment". In Benedict, SH; Schlesinger, DJ; Goetsche, SJ; Kavanagh, BD (eds.). Stereotactic Radiosurgery and Stereotactic Body Radiation Therapy. Boca Raton: CRC Press. pp. 156–159. doi:10.1201/b16776. ISBN 978-1-4398-4198-3. S2CID 58555632.
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