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Review
. 2025 Mar 1;28(3):303-321.
doi: 10.1227/ons.0000000000001422. Epub 2024 Dec 2.

Principles of Stereotactic Surgery

Michael A Jensen  1 , Joseph S Neimat  2 , Panagiotis Kerezoudis  1 , Rushna Ali  1 , R Mark Richardson  3 , Casey H Halpern  4 , Steven G Ojemann  5 , Francisco A Ponce  6 , Kendall H Lee  1 , Laura M Haugen  1 , Fiona E Permezel  7 , Bryan T Klassen  7 , Douglas Kondziolka  8 , Kai J Miller  1
Affiliations
Review

Principles of Stereotactic Surgery

Michael A Jensen et al. Oper Neurosurg. .

Abstract

Background and objectives: Stereotactic procedures are used to manage a diverse set of patients across a variety of clinical contexts. The stereotactic devices and software used in these procedures vary between surgeons, but the fundamental principles that constitute safe and accurate execution do not. The aim of this work is to describe these principles to equip readers with a generalizable knowledge base to execute and understand stereotactic procedures.

Methods: A combination of a review of the literature and empirical experience from several experienced surgeons led to the creation of this work. Thus, this work is descriptive and qualitative by nature, and the literature is used to support instead of generate the ideas of this framework.

Results: The principles detailed in this work are categorized based on 5 clinical domains: imaging, registration, mechanical accuracy, target planning and adjustment, and trajectory planning and adjustment. Illustrations and tables are used throughout to convey the concepts in an efficient manner.

Conclusion: Stereotactic procedures are complex, requiring a thorough understanding of each step of the workflow. The concepts described in this work enable functional neurosurgeons with the fundamental knowledge necessary to provide optimal patient care.

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