Stereotaxis

The stereotatic technique enables operations on deep brain structures with minimal tissue damage in the approach path.
 * They are puncture procedures performed with a targeted trepanation drill bit with high targeting accuracy.
 * They are used either in functional neurosuregery (affecting dyskinesia) or as a puncture biopsy, evacuation of cysts, abscessses, etc.
 * For orientation, the patient has a stereotaxic device fixed on is head.

Functional operations

 * The target structures are deep structures in the brain (nuclei of the thalamus, BG, etc.).
 * Aiming is done using reference points in the vicinity III. ventricles (anterior commisure and posterior commissure) – shown by MRI or ventriculography.
 * The procedure itself is the targeted destruction of the tissue of a defined volume, most often we do it with a high-frequency current or gamma radiation (LGK).
 * Procedures are performed under LA (local anesthesia), due to contact with the patient - the possibility of clinical and EEG monitoring.
 * Two phases:
 * after deploying the device, we aim at the points according to the MRI, determine the target point;
 * we make a trepanation drill bit and introduce the probe using the guidance device.


 * the stereotatic frame is made of special materials so as not to interfere with imaging techniques

Indication

 * The most common are various forms of dysinesia.
 * Often in Parkinson's disease - in the case of pharmacologically uncontrolled tremor, which also affects rigidity, coagulation lesions are made in the nuclei of the thalamus, in the subthalamus and in the pallidum.
 * Other controllable dyskinesias – chorea, athetosis, hemiballismus.
 * In children with severe forms of DMO,dentate nucleus is destroyed of the cerebellum → we reduce muscle hypertonus.
 * Less common indications:
 * chronic pain (nonspecific thalamic nuclei);
 * psychoses – bilateral cingulate gyrus coagulation.
 * Sometimes we can implant electrodes and stimulate long-term.