Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2009 May;4(3):273-80.
doi: 10.1007/s11548-009-0292-3. Epub 2009 Feb 28.

Customized, rapid-production microstereotactic table for surgical targeting: description of concept and in vitro validation

Robert F Labadie  1 , Jason Mitchell, Ramya Balachandran, J Michael Fitzpatrick
Affiliations
Comparative Study

Customized, rapid-production microstereotactic table for surgical targeting: description of concept and in vitro validation

Robert F Labadie et al. Int J Comput Assist Radiol Surg. 2009 May.

Abstract

Purpose: To introduce a novel microstereotactic frame, called the Microtable, consisting of a tabletop that mounts on bone-implanted spherical markers. The microtable is customized for individual patient anatomy to guide a surgical instrument to a specified target.

Methods: Fiducial markers are bone-implanted, and CT scanning is performed. A microtable is custom-designed for the location of the markers and the desired surgical trajectory and is constructed using a computer-numerical-control machine. Validation studies were performed on phantoms with geometry similar to that for cochlear implant surgery. Two designs were tested with two different types of fiducial markers.

Results: Mean targeting error of the microtables for the two designs were 0.37 +/- 0.18 and 0.60 +/- 0.21 mm (n = 5). Construction of each microtable required approximately 6 min.

Conclusions: The new frame achieves both high accuracy and rapid fabrication. We are currently using the microtable for clinical testing of the concept of percutaneous cochlear implant surgery.

PubMed Disclaimer

Figures

Fig 1
Fig 1
(a) In the simplest implementation of the microtable concept, three spherical fiducial markers are used. The tabletop is elevated above the spherical fiducial markers using legs to orient it perpendicularly to the trajectory. (b) Two example configurations of bone-implanted anchor and extender for the spherical fiducial marker illustrating that specific location and orientation of the anchors are relatively unimportant.
Fig 2
Fig 2. Flowchart explaining steps involved for clinical application
Fig 3
Fig 3
(a) Spherical fiducial markers atop extenders anchored to the skull; (b) Legs attached to spherical fiducial markers. The planned trajectory is shown as a red cylinder.
Fig 4
Fig 4. Countersinking of the legs such that the tabletop is perpendicular to the trajectory
Fig 5
Fig 5. Microtable with CNC tool paths shown in green
Fig 6
Fig 6. Quality assurance by measuring distances between holes
Fig 7
Fig 7
Coupling mechanism between spherical fiducial marker and table leg. The inset shows a close up of one coupling. Twisting the thumbscrew tightens the grippers, thereby fixing the leg to the marker.
Fig 8
Fig 8
Microtable attached to patient with surgical instrument attached via a holder to the tabletop and ready for procedural intervention.
Fig 9
Fig 9
Phantom as used in coordinate measuring machine (CMM). (a) Microtable mounted on the spherical markers in a phantom. (b) Physical localization of spheres using the CMM.
Fig 10
Fig 10
Microtable mounted on the patient's head for validation. The Microtable was fabricated intraoperatively for cochlear implantation for the patient.
See this image and copyright information in PMC

References

    1. Maurer CR, Jr, Fitzpatrick JM, Wang MY, et al. Registration of head volume images using implantable fiducial markers. IEEE Transactions on Medical Imaging. 1997;16:447–462. - PubMed
    1. Woerdeman PA, Willems PWA, Noordmans HJ, et al. Application accuracy in frameless image-guided neurosurgery: a comparison study of three patient-to-image registration methods. Journal of Neurosurgery. 2007;106(6):1012–1016. - PubMed
    1. Brown RA. System using computed tomography as for selective body treatment. Patent No. 4,608,977. United States Patent and Trademark Office; 1986 filed 1982, granted 1986.
    1. Maciunas RJ, Galloway RL, Jr, Latimer JW. The application accuracy of stereotactic frames. Neurosurgery. 1994;35:682–694. - PubMed
    1. Yu C, Apuzzo ML, Zee CS, Petrovich Z. A phantom study of the geometric accuracy of computed tomographic and magnetic resonance imaging stereotactic localization with the Leksell stereotactic system. Neurosurgery. 2001;48:1092–1099. - PubMed

Publication types