USE OF A FRAMELESS, ARMLESS STEREOTAXIC WAND FOR BRAIN-TUMOR LOCALIZATION WITH 2-DIMENSIONAL AND 3-DIMENSIONAL NEUROIMAGING

PRELIMINARY EXPERIENCE WITH a frameless, armless stereotactic localiza tion system in brain tumor surgery is presented. The localizing wand e mits ultrasonic pulses that are detected by a table-mounted array of m icrophones-with triangulation of the emitter positions. The wand tip a nd trajectory are determined by proprietary computer software. Real-ti me display of this information is presented in multiple, two-dimension al or three-dimensional displays. Forty-eight patients underwent 52 cr aniotomies for brain tumors. The wand was used to assist in placing a minimal craniotomy in 48 cases, to determine the tumor/brain interface in 27 cases, to localize subcortical tumors in 14 cases, and to corre late the physiological mapping with the surface anatomy in 5 cases. In 12 instances, the wand was used in conjunction with frame stereotaxy and found to be comparable or superior. Triplanar (coronal, sagittal, transverse) two-dimensional images provided sufficient information for the detection of tumor boundaries but proved difficult to use to acce ss a subcortical lesion; two-dimensional or three-dimensional images a long the localization axis were more helpful. Frameless stereotaxy wit h this sonic wand system proved to be a useful adjunct to open-tumor b iopsy or resection.