Stereotactically guided craniotomy for transsulcal exposure of small subcortical lesions adjacent to eloquent areas

Abstract

Stereotactic localization with a frame not only targets small subcortical lesions, but also augments transsulcal entrance to such lesions. Leibinger stereotactic system (ZD Stereotaxy System, Leibenger, Muhlheim-Stetten-Germany) is used in our neurosurgical interventions to expose small subcortical lesions. Preoperative frame fixation and calculation of lesion coordinates is followed by awake minicraniotomy and transsulcal exposure of the lesion. In this stereotactic system, free floating direction of the stereotactic needle without deviation from the target after coordinates of the lesion are secured was the key point to allow transsulcal entrance to such lesions. Stereotactically guided intervention with a frame was found to be very effective in locating the small subcortical lesions through sulci, allowing less invasive surgery. Like frameless stereotaxy, stereotaxy with frame allowing free movement of stereotactic needle without deviation from final target is also effectively used in transsulcal exposure of small subcortical lesions.