9/14/2011. TÁMOP –4.1.2-08/2/A/KMR-2009-0006 1 Developmentof Complex Curricula for Molecular Bionics and Infobionics Programs within a consortial* framework** Consortium leader PETER PAZMANY CATHOLIC UNIVERSITY Consortium members SEMMELWEIS UNIVERSITY, DIALOG CAMPUS PUBLISHER The Project has been realised with the support of the European Union and has been co-financed by the European Social Fund *** **Molekuláris bionika és Infobionika Szakok tananyagának komplex fejlesztése konzorciumi keretben ***A projekt az Európai Unió támogatásával, az Európai Szociális Alap társfinanszírozásával valósul meg. PETER PAZMANY CATHOLIC UNIVERSITY SEMMELWEIS UNIVERSITY sote_logo.jpg dk_fejlec.gif INFOBLOKK Peter Pazmany Catholic University Faculty of Information Technology www.itk.ppke.hu (Neurális interfészek és protézisek ) LECTURE4 STEREOTAXICTECHNIQUE –NAVIGATION IN THE BRAIN (Sztereotaxikusmódszer –helymeghatározás az agyban) GYÖRGY KARMOS NEURALINTERFACESAND PROSTHESES NEURALINTERFACESAND PROSTHESESSTEREOTAXICTECHNIQUE–NAVIGATIONINTHE BRAIN 9/14/2011 TÁMOP –4.1.2-08/2/A/KMR-2009-0006 3 AIMS: In thislecturethestudentswillgetacquantedwiththeprincipleof thestereotaxictechnique. Exampleswillbe presentedfromanimalresearchand thehuman applicationof thestereotaxicmethodwillbe discussed. Inmodern neurosurgeryneuronavigationmethodis alsousedforlocalizationstructuresinthebrain. Thistechniquedoesnotneedframefixed totheheadof thepatient. Presentdayneurosurgeryusescomputer softwaresforfusionof neuroimagingdatainordertoplansurgicalapproachesinthebrain. www.itk.ppke.hu NEURALINTERFACESAND PROSTHESESSTEREOTAXICTECHNIQUE–NAVIGATIONINTHE BRAIN 9/14/2011 TÁMOP –4.1.2-08/2/A/KMR-2009-0006 4 By the beginingof the 20th Century neurophysiologist started the functional study of the subcortical brain structures. A method was needed to exactly localize these deep-seated nuclei. In 1908 two English scientists, Victor A. Horsley and Robert H. Clarke invented the stereotaxic apparatus called for a long period „Horsley-Clarke apparatus”. This served for intracerebralnavigation in vertebrates. The method was further developed by S. W Ransonin the USA in the thirties. Stereotaxic atlases were published for the different species. Nowadays most experimental manipulations in the vertebrate brains are done with the help of the stereotaxic method. www.itk.ppke.hu The firststereotaxicapparatusof Horsleyand Clarke (1908) HISTORYOF ANIMALSTEREOTAXICTECHNIQUE NEURALINTERFACESAND PROSTHESESSTEREOTAXICTECHNIQUE–NAVIGATIONINTHE BRAIN 9/14/2011 TÁMOP –4.1.2-08/2/A/KMR-2009-0006 5 DEFINITIONS The term stereotaxic comes from the Greek stereos: solid and tassein: arrange. Stereotaxic apparatus consists of a metal frame that serves for rigid fixation of the head of the animal in reference to the coordinate system. In rodents the head is fixed by two ear bars inserted into the external auditory meatiand the tooth bar over which the front teeth are placed. Reference points are also on the skull the bregmaand lambda sutures. In cats two ear bars and two eye bars placed on the inferior orbital ridges are used. The frame also serves as the base for the manipulation of the positioners or electrode holders in the three dimensional coordinate system. Stereotaxic atlas contains cell and fiber stained brain sections as well as schematic figures based on these sections. Sections are made in all three dimensions: front -rear direction, medial -lateral direction, dorsal -ventral direction. www.itk.ppke.hu NEURALINTERFACESAND PROSTHESESSTEREOTAXICTECHNIQUE–NAVIGATIONINTHE BRAIN • STEREOTAXIC APPARATUS FOR CATS AND MONKEYS 2011.09.14.. TÁMOP –4.1.2-08/2/A/KMR-2009-0006 6 101-0103_IMG Ear bar Stereotaxic frame Electrode holder Electrode manipulator Eye bar KOPF MODEL 1404 www.itk.ppke.hu The electrodemanipulatoris identicalinthecat/monkeyand inthesmallanimalstereotaxicapparatus. Thisshowsthesizedifferenceof thefraims. www.itk.ppke.hu 2011.09.14.. TÁMOP –4.1.2-08/2/A/KMR-2009-0006 7 SMALL ANIMALSTEREOTAXIC INSTRUMENT Electrode manipulator Stereotaxic frame Ear bar Electrode holder nose and tooth bar assembly KOPFMODEL 902 NEURALINTERFACESAND PROSTHESESSTEREOTAXICTECHNIQUE–NAVIGATIONINTHE BRAIN The electrodemanipulatoris identicalinthecat/monkeyand inthesmallanimalstereotaxicapparatus. Thisshowsthesizedifferenceof thefraims. NEURALINTERFACESAND PROSTHESESSTEREOTAXICTECHNIQUE–NAVIGATIONINTHE BRAIN 9/14/2011 TÁMOP –4.1.2-08/2/A/KMR-2009-0006 8 CHRONICELECTRODEIMPLANTATIONINRAT Chronic electrode implantation means that the animal recovers from the operation with the implanted electrodes fixed to its skull. After recovery multiple recording or stimulation sessions can be performed with this animal. The operation is carried out in surgical anesthesia with sterilized instruments. The chronically implanted electrodes are usually thin enamel insulated tissue friendly stainlesssteelwires. Twisted wire electrodes areeasy to fabricate. Theyareusedfordeepbrainrecordingorstimulation, theycause relatively little harm to brain tissue and provide stable recordings for long time. The electrodes are fixed to the skull by dental filling and acrylic materials. For recording of brain electrical activity stainless screwsare fixed into the skull as reference and ground electrodes. The electrodes are connected to miniature multicontactsocket to which the multileadcable can be connected for the time of the experiments. Chronically implanted rat can be used in behavioral experiments for months. www.itk.ppke.hu NEURALINTERFACESAND PROSTHESESSTEREOTAXICTECHNIQUE–NAVIGATIONINTHE BRAIN 2011.09.14.. TÁMOP –4.1.2-08/2/A/KMR-2009-0006 9 RATSKULLINTHESTEREOTAXICFRAME The three coordinates are indicated: A-P.: front -rear direction Lat.: medial -lateral direction Vert.: dorsal -ventral direction www.itk.ppke.hu NEURALINTERFACESAND PROSTHESESSTEREOTAXICTECHNIQUE–NAVIGATIONINTHE BRAIN 2011.09.14.. TÁMOP –4.1.2-08/2/A/KMR-2009-0006 10 STEREOTAXICCOORDINATES Two pages of the stereotaxic atlas. Left the histological section, right the map of the structures with the coordinates. Paxinos, G., Watson, C., The RatBraininStereotaxicCoordinates 6thed., AcademicPress,2009. www.itk.ppke.hu NEURALINTERFACESAND PROSTHESESSTEREOTAXICTECHNIQUE–NAVIGATIONINTHE BRAIN 2011.09.14.. TÁMOP –4.1.2-08/2/A/KMR-2009-0006 11 ANESTHETIZED RAT FIXED IN THE STEREOTAXIC FRAME The head is fixed by the ear bars and the nose and tooth bar assembly. www.itk.ppke.hu NEURALINTERFACESAND PROSTHESESSTEREOTAXICTECHNIQUE–NAVIGATIONINTHE BRAIN 2011.09.14.. TÁMOP –4.1.2-08/2/A/KMR-2009-0006 12 STEREOTAXICELECTRODEIMPLANTATION1 Holesintheskullaremade bya drill fixed inthestereotaxicmanipulator. www.itk.ppke.hu NEURALINTERFACESAND PROSTHESESSTEREOTAXICTECHNIQUE–NAVIGATIONINTHE BRAIN 2011.09.14.. TÁMOP –4.1.2-08/2/A/KMR-2009-0006 13 STEREOTAXICELECTRODEIMPLANTATION2 Three pairs of twisted wire electrodes arefixed in the electrode holder. The enamel insulation isremoved from the tip of the wires (right). At the other end of thewiresfemale connectors are crimped (left). Drops of adhesive are used to fix the twisted wires. www.itk.ppke.hu NEURALINTERFACESAND PROSTHESESSTEREOTAXICTECHNIQUE–NAVIGATIONINTHE BRAIN STEREOTAXICELECTRODEIMPLANTATION3 2011.09.14.. TÁMOP –4.1.2-08/2/A/KMR-2009-0006 14 G:\My Documents\My Pictures\2011patkánymûtét\Anna\DSCF6898c.jpg Threepairs of electrodes are inserted into the brain according to the stereotaxic coordinates. www.itk.ppke.hu NEURALINTERFACESAND PROSTHESESSTEREOTAXICTECHNIQUE–NAVIGATIONINTHE BRAIN 2011.09.14.. TÁMOP –4.1.2-08/2/A/KMR-2009-0006 15 STEREOTAXICELECTRODEIMPLANTATION4 The electrodes are fixed to the skull by light curing dental adhesive. www.itk.ppke.hu NEURALINTERFACESAND PROSTHESESSTEREOTAXICTECHNIQUE–NAVIGATIONINTHE BRAIN STEREOTAXICELECTRODEIMPLANTATION5 2011.09.14.. TÁMOP –4.1.2-08/2/A/KMR-2009-0006 16 Sevenpairsof electrodesareimplantedand fixed totheskull. www.itk.ppke.hu NEURALINTERFACESAND PROSTHESESSTEREOTAXICTECHNIQUE–NAVIGATIONINTHE BRAIN STEREOTAXICELECTRODEIMPLANTATION6 2011.09.14.. TÁMOP –4.1.2-08/2/A/KMR-2009-0006 17 The miniature connectors were inserted into the body of the connector and the wholeimplant is fixed to the skull by dental acrylic. Finally the wound is closed by sutures. www.itk.ppke.hu NEURALINTERFACESAND PROSTHESESSTEREOTAXICTECHNIQUE–NAVIGATIONINTHE BRAIN STEREOTAXICELECTRODEIMPLANTATION7 2011.09.14.. TÁMOP –4.1.2-08/2/A/KMR-2009-0006 18 Next day after the implantation the rat is welland readyforthebehavioralexperiments. www.itk.ppke.hu NEURALINTERFACESAND PROSTHESESSTEREOTAXICTECHNIQUE–NAVIGATIONINTHE BRAIN 9/14/2011 TÁMOP –4.1.2-08/2/A/KMR-2009-0006 19 THE BEGINNINGOF MODERN NEUROSURGERY www.itk.ppke.hu Harvey Cushing(1869-1939) NEURALINTERFACESAND PROSTHESESSTEREOTAXICTECHNIQUE–NAVIGATIONINTHE BRAIN 9/14/2011 TÁMOP –4.1.2-08/2/A/KMR-2009-0006 20 www.itk.ppke.hu NEURONAVIGATION Minimal invasive neurosurgery is becoming more and more standard in neurosurgical procedures. Neuronavigationis important technique in this. Sterotacticneurosurgery represent the „frame based” neuronavigation. The other method is the „frameless” neuronavigation. Both methods are based on brain imaging like MR, CT and PET. NEURALINTERFACESAND PROSTHESESSTEREOTAXICTECHNIQUE–NAVIGATIONINTHE BRAIN 9/14/2011 TÁMOP –4.1.2-08/2/A/KMR-2009-0006 21 STEREOTAXICTECHNIQUEINHUMANS Modern neurosurgery dates back to the period of Harvey Cushing (1869-1939). Stereotaxic method (or as is written in most neurosurgical text stereotactic method) was rarely used since the Horsley -Clarke apparatus could not be adapted for humans because there were no good reference points. Only modern imaging techniques solved this problem. The up to date human stereotactic method was developed by American (Ernest A. Spiegel and Henry T. Wycis, 1947) and Swedish (Lars Leksell, 1949) neurosurgeons. They used intracerebralreference points, Spiegel and Wycisused traditional Cartesian coordinates while Leksellintroduced the polar coordinate system that easier can be calibrated in the operating room. Human application of stereotactic technique opened the door for the development of functional neurosurgery and nowadays many thousands suffering Parkinson’s disease and other movement disorders are helped by minimalinvasiveneurosurgical interventions. www.itk.ppke.hu NEURALINTERFACESAND PROSTHESESSTEREOTAXICTECHNIQUE–NAVIGATIONINTHE BRAIN 9/14/2011 TÁMOP –4.1.2-08/2/A/KMR-2009-0006 22 TALAIRACHCOORDINATES Jean Talairach(1911-2007) French neurosurgeon developed the human brain coordinate system, named after him. It uses intracerebralreference points. They are the horizontal line connectingthe anterior and posterior commissuresserving a vertical zero. The midsagitalplane through these points serves the vertical coordinate. The rostral-caudal coordinates are measured from the anterior commissure. The limitation of this atlas is that there are large size differences in the human brains. www.itk.ppke.hu Today using Magnetic Resonance Imaging (MRI) and Positron Emission Tomography (PET) stereotacticparameters can be exactly defined in each individual patient. Still the data can be adapted to the atlas data that makes the surgical planning easier. Talairachcoordinates NEURALINTERFACESAND PROSTHESESSTEREOTAXICTECHNIQUE–NAVIGATIONINTHE BRAIN G:\TÁMOP_PROSTH\steretoax_anyag\elekta\logo.jpg 9/14/2011 TÁMOP –4.1.2-08/2/A/KMR-2009-0006 23 LEKSELLSTEREOTACTICSYSTEM® www.itk.ppke.hu LarsLeksell1907-1986 The LeksellStereotactic System was developed by Lars Leksell, the professor of he KarolinskaInstitute. The basic components of the LeksellStereotactic System are the Coordinate Frame and the Multi Purpose Stereotactic Arc. Frame Arch www.electa.com NEURALINTERFACESAND PROSTHESESSTEREOTAXICTECHNIQUE–NAVIGATIONINTHE BRAIN 9/14/2011 TÁMOP –4.1.2-08/2/A/KMR-2009-0006 24 The Frame is fixed to the patients head with four screws in local anesthesia. MRI, CT or Angiocan be made while the frame is attached. The indicator box generates positional marks during scanning. www.electa.com www.itk.ppke.hu G:\TÁMOP_PROSTH\steretoax_anyag\elekta\stereotactic system005.jpg LEKSELLSTEREOTACTICSYSTEM® NEURALINTERFACESAND PROSTHESESSTEREOTAXICTECHNIQUE–NAVIGATIONINTHE BRAIN 9/14/2011 TÁMOP –4.1.2-08/2/A/KMR-2009-0006 25 LEKSELLSTEREOTACTICSYSTEM® AC: anteriorcommisure PC: posteriorcommisure www.itk.ppke.hu The Frame serves as the base of the coordinate system. The target point can be determined in relation to the AC-PC line. The positioner attached to the Arch can reach any structure in the cerebrum. www.electa.com Z X Y NEURALINTERFACESAND PROSTHESESSTEREOTAXICTECHNIQUE–NAVIGATIONINTHE BRAIN 9/14/2011 TÁMOP –4.1.2-08/2/A/KMR-2009-0006 26 LEKSELLSTEREOTACTICSYSTEM® www.itk.ppke.hu ELATERALL The flexibility of the System makes possible the approach from different directions. www.electa.com NEURALINTERFACESAND PROSTHESESSTEREOTAXICTECHNIQUE–NAVIGATIONINTHE BRAIN 9/14/2011 TÁMOP –4.1.2-08/2/A/KMR-2009-0006 27 ElektaEndoscope Adapter serves for biopsy, LeksellMicroDrivefor positioning recording and stimulating electrodes. www.itk.ppke.hu G:\TÁMOP_PROSTH\steretoax_anyag\220px-Brain_biopsy_under_stereotaxy.jpg G:\TÁMOP_PROSTH\steretoax_anyag\Leksell\Elekta-Microdrive.jpg LEKSELLSTEREOTACTICSYSTEM® Brainbiopsy LeksellMicroDrive www.electa.com NEURALINTERFACESAND PROSTHESESSTEREOTAXICTECHNIQUE–NAVIGATIONINTHE BRAIN 9/14/2011 TÁMOP –4.1.2-08/2/A/KMR-2009-0006 28 LeksellSurgiPlan® www.itk.ppke.hu LeksellSurgiPlan®is an advanced image-based neurosurgical planning software, specifically designed for LeksellStereotactic System®. The Linux operating system based modular platform combines advanced image handling options with a new graphic interface for excellent ease-of-use. www.electa.com NEURALINTERFACESAND PROSTHESESSTEREOTAXICTECHNIQUE–NAVIGATIONINTHE BRAIN 9/14/2011 TÁMOP –4.1.2-08/2/A/KMR-2009-0006 29 LeksellSurgiPlan® www.itk.ppke.hu Pre-operative planning can be made through co-registration of frame-based and frameless image studies from CT and MR scanners. LeksellSurgiPlansoftware can import CT, MR and angiographic images. Once images are imported, they are automatically scaled. www.electa.com NEURALINTERFACESAND PROSTHESESSTEREOTAXICTECHNIQUE–NAVIGATIONINTHE BRAIN 9/14/2011 TÁMOP –4.1.2-08/2/A/KMR-2009-0006 30 LeksellSurgiPlan® www.itk.ppke.hu Interactive image fusion of CT and MRimages. The fused images have thesame high accuracy as the originalimages, since both image studiesare defined in Leksellstereotacticspace by LeksellCoordinate Frame. NEURALINTERFACESAND PROSTHESESSTEREOTAXICTECHNIQUE–NAVIGATIONINTHE BRAIN 9/14/2011 TÁMOP –4.1.2-08/2/A/KMR-2009-0006 31 Targets can be easily defined withthesemi-automaticoutlinefunction, which also allows for complexnon-continuousregions. www.itk.ppke.hu LeksellSurgiPlan® www.electa.com NEURALINTERFACESAND PROSTHESESSTEREOTAXICTECHNIQUE–NAVIGATIONINTHE BRAIN 9/14/2011 TÁMOP –4.1.2-08/2/A/KMR-2009-0006 32 www.itk.ppke.hu LeksellSurgiPlan® Cross-hair position correlates all open views and different imaging modalities. Real time image reformatting, continuous zoom and gray scale mapping gives immediate visual feedback for fast and accurate planning. NEURALINTERFACESAND PROSTHESESSTEREOTAXICTECHNIQUE–NAVIGATIONINTHE BRAIN 9/14/2011 TÁMOP –4.1.2-08/2/A/KMR-2009-0006 33 It offers powerful functions to visualize and analyze patient imagesdisplayed in different 3-D renderings, facilitating more complete planning validation. www.itk.ppke.hu C:\Documents and Settings\gkarmos\Desktop\Kép2.gif LeksellSurgiPlan® NEURALINTERFACESAND PROSTHESESSTEREOTAXICTECHNIQUE–NAVIGATIONINTHE BRAIN 9/14/2011 TÁMOP –4.1.2-08/2/A/KMR-2009-0006 34 NEUROSURGICALAPPLICATIONOF STERETACTICTECHNIQUE LeksellGamma Knife® In 1968 Lars Leksellintroduced gamma knife surgery. In 1986 first commercially dedicated LeksellGamma Knife was introduced. The principle of gamma surgery is that high intensity gamma radiation kills cancer cells and shrinks tumors. The aim is to focus a series of low intensity gamma radiation beams to one single point in the brain where the tumor or malformation is.This is done by the Gamma knife. www.itk.ppke.hu G:\TÁMOP_PROSTH\steretoax_anyag\800px-Elekta_Leksell_Gamma_Knife.jpg NEURALINTERFACESAND PROSTHESESSTEREOTAXICTECHNIQUE–NAVIGATIONINTHE BRAIN 9/14/2011 TÁMOP –4.1.2-08/2/A/KMR-2009-0006 35 LEKSELLGAMMA KNIFE® www.itk.ppke.hu G:\TÁMOP_PROSTH\steretoax_anyag\Leksell\helmet2.jpg D:\My Documents2\My Pictures\vlcsnap-2011-05-13-20h58m53s180.png Gamma Knife typically contains 201cobalt-60 sources of approximately 30curies(1.1TBq), each placed in a circular array in a heavily shielded assembly. The radiation beams converge with high accuracy on the target. Each individual beam has low intensity and therefore does not affect the tissue through which it passes on its way to the target. The beams converge in an isocenterwhere the cumulative radiation intensity becomes extremely high. The extreme precision of LeksellGamma Knife, better than 0.5mm, makes it possible to administer a high radiation dose to the lesion with minimal risk of damaging healthy tissue. NEURALINTERFACESAND PROSTHESESSTEREOTAXICTECHNIQUE–NAVIGATIONINTHE BRAIN 9/14/2011 TÁMOP –4.1.2-08/2/A/KMR-2009-0006 36 GAMMA KNIFESURGERY www.itk.ppke.hu The first step of LeksellGamma Knife surgery is to precisely pinpoint the tumor or other problem by the special stereotactic head frame. Head frame in place MRI and CT scans are made to precisely locate the size, shape and location of thetumor, lesion or abnormality. On the basis of the images using LeksellGammaPlan®3-D planning software, a treatment protocol is planned. Once theprotocolis complete, the next step is the treatment.With the head frame attached to the helmet the radiation is done. With very few exceptions, Gamma Knife surgery is given on asingle occasion and without general anesthesia. During the procedure the patient can communicate with the Gamma Knife team through a video and audio connection. A treatment lasts from two to forty-five minutes. NEURALINTERFACESAND PROSTHESESSTEREOTAXICTECHNIQUE–NAVIGATIONINTHE BRAIN 9/14/2011 TÁMOP –4.1.2-08/2/A/KMR-2009-0006 37 GAMMA KNIFESURGERY www.itk.ppke.hu Gamma knife surgery is a bloodless surgery for neurological diseases. The surgery does require the skull to be opened for performance of the operation. Gamma knife surgery iseffective for patients with benign ormalignant brain tumors, vascularmalformations such as an arteriovenousmalformation(AVM). Several published studies demonstrate savings of more than 50% of direct costs associated with microsurgery. More than 500000 patients were treated by Leksellgamma knife until December 2009. NEURALINTERFACESAND PROSTHESESSTEREOTAXICTECHNIQUE–NAVIGATIONINTHE BRAIN 9/14/2011 TÁMOP –4.1.2-08/2/A/KMR-2009-0006 38 FRAMELESSNEURONAVIGATION www.itk.ppke.hu Framelessneuronavigationsystems enable thesurgeons to visualize the anatomy of a patient’s brain during surgery and precisely track the location of their surgical instruments in relation to thebrainanatomy. Differenttechniquesareusedforneuronavigationand instrumentaltracking: Ultrasoundimpulses, orinfraredLED flashesreflectedfromspeciallycoatedsphericalmarkersaredetected. PC basedsystemsgeneratelocationof thepatient’s headpositionand themomenttomomentpositionof theinstrument. Theseareintegratedwiththevariousimagindata. www.medtronic.com NEURALINTERFACESAND PROSTHESESSTEREOTAXICTECHNIQUE–NAVIGATIONINTHE BRAIN 9/14/2011 TÁMOP –4.1.2-08/2/A/KMR-2009-0006 39 Triangle marker array is fixed to the patient’s head holder in a rigid position. On the operating instruments similar fiducialreference systemsare located. This way both the head and the instrument data are available in the computer. Complex mathematical algorithms via robust computer technologies made possible the real-time quantitative spatial fusion of images of the patient's brain with the created “fiducialcoordinate system”. The pre-surgery information integrated to the patient’s real anatomy and converted into 3Dimages. The technique provides surgeons with a way to navigate through the brain using the 3Dimages. www.itk.ppke.hu FRAMELESSNEURONAVIGATION . NEURALINTERFACESAND PROSTHESESSTEREOTAXICTECHNIQUE–NAVIGATIONINTHE BRAIN 9/14/2011 TÁMOP –4.1.2-08/2/A/KMR-2009-0006 40 Application areas of frameless neuronavigationtechniques: tumor biopsies visualization of critical brain structures tumor resection Image-guided surgery has revolutionized traditional surgical techniques by providing a precise treatment guidance system that can help ensure the safety of vital structures, while providing the best outcome for patients. www.itk.ppke.hu FRAMELESSNEURONAVIGATION NEURALINTERFACESAND PROSTHESESSTEREOTAXICTECHNIQUE–NAVIGATIONINTHE BRAIN 9/14/2011 TÁMOP –4.1.2-08/2/A/KMR-2009-0006 41 Oneof theexampleoftheframelessneuronavigtioninstrumentsis theStealthStation®S7®, Medtronic’s seventh generation surgical navigation system. Surgeons can choose between Medtronic’s advanced optical surgical navigation camera, or the AxiEM™trackingsystem. AxiEM™surgical navigation system,is electromagnetic(EM) tracking technology developed by Medtronic Navigation. Itisthe industry’s first clinically available EMtracking solution to use unique single-coil engineering. It works by generating an electromagnetic field around the patient’s target anatomy that can be tracked to triangulate the positioning of instrumentsand patient-tracking devices during surgical navigation. www.itk.ppke.hu STEALTHSTATIONS7SURGICAL NAVIGATION SYSTEM www.medtronic.com G:\TÁMOP_PROSTH\Neuronavigation\Medtronic_logo.jpg NEURALINTERFACESAND PROSTHESESSTEREOTAXICTECHNIQUE–NAVIGATIONINTHE BRAIN 9/14/2011 TÁMOP –4.1.2-08/2/A/KMR-2009-0006 42 REFERENCES A StereotaxicAtlas of theDiencephalonoftheCAt, Jasper, H.H., and Ajmone_Marsan, C., National Research Counbcilof Canada, Ottava. 1954. Snieder,R.S., Niemer, W.T.:Stereotaxicatlasof thecatbrain, Univ. of ShicagoPress, Chicago, 1961. Paxinos, G., Watson, C.: The RatBraininStereotaxicCoordinates, 6thed., AcademicPress,2009. Talairach, J.,Tournoux, P.: , "ReferentiallyOriented CerebralMRIAnatomy: An Atlas of StereotaxicAnatomicalCorrelationsforGray and White Matter", ThiemeMedicalPublishers, New York, 1993 Chin,,L.; Regine,W. F. (Eds.): Principlesand Practiceof StereotacticRadiosurgerySpringer, 2008. www.kopfinstruments.com www.electa.com www.medtronic.com http://www.neurosurgery.org/cybermuseum/stereotactichall/stereoarticle.html. http://www.waparkinsons.org/edu_research/articles/Stereotactic_Surgery.html http://www.bookrags.com/tandf/stereotaxic-surgery-tf/#p200045188830756003 http://www.med-ars.it/galleries/neurology www.itk.ppke.hu NEURALINTERFACESAND PROSTHESESSTEREOTAXICTECHNIQUE–NAVIGATIONINTHE BRAIN 9/14/2011 TÁMOP –4.1.2-08/2/A/KMR-2009-0006 43 REVIEW QUESTIONS: • What are the stereotaxic reference points in rat? • What are the stereotactic reference points in human? • Who were the founders of the human stereotactic surgery? • What does interactive image fusion means? • How the gamma knife surgery is done? • How does frameless neuronavigationworks? • Whataretheapplicationareasof theneuronavigation? www.itk.ppke.hu