What is a Frame-Based and Image-Guided Stereotactic Resection?
A craniotomy is the basic surgical technique employed in the resection of a lesion or tumor in the brain. The procedure involves making a surgical cut in the scalp and creating a bony opening in the skull. This bony opening allows access to the brain or intracranial space where the tumor is located.
Frame-based and image-guided stereotactic resection is a minimally invasive surgical procedure employed in craniotomy for the precise diagnosis and resection of a lesion or tumor located deep inside the brain that is considered difficult-to-reach or inoperable with a normal craniotomy procedure.
Stereotactic-guided surgery, also known as stereotaxy, utilizes advanced computers to precisely locate a brain lesion or tumor and form a three-dimensional picture of it. Frame-based stereotaxy utilizes a lightweight stereotactic head frame fastened to the patient’s skull. Magnetic resonance imaging (MRI) or computerized tomography (CT) scans are taken. The stereotactic frame shows up on the scan and assists to pinpoint the precise location of the tumor. The frame acts as a reference point to exactly guide the instruments through a burr hole (a dime-sized hole made on the skull to perform craniotomy).
Frame-based and image-guided stereotactic resection enables your neurosurgeon to exactly map the site of the tumor and establish the most effective way to resect it. It helps your surgeon to make the distinction between tumor tissue and healthy tissue, reach the exact location of the tumor tissue, and resect as much of the tumor as possible without damaging surrounding healthy tissue.
Benefits of Frame-Based and Image-Guided Stereotactic Resection
Frame-based and image-guided stereotactic resection is a minimally invasive surgery that offers the following benefits:
- Small incisions
- Minimal scarring
- Minimal soft-tissue trauma
- Faster wound healing
- Ability to navigate precisely within the brain and tumor tissue
- High-level of safety and precision during tumor resection
- Leaves normal, healthy brain tissue relatively intact
Indications for Frame-Based and Image-Guided Stereotactic Resection
Frame-based and image-guided stereotactic resection is mainly indicated for diagnosing and treating brain abnormalities, such as:
- Biopsy of abnormal tissue
- Aspiration from abscesses, cysts, or hematomas
- Metastatic brain tumors
- Pituitary adenomas
- Pituitary tumor
Preparation for Frame-Based and Image-Guided Stereotactic Resection
Pre-procedure preparation for frame-based and image-guided stereotactic resection will involve the following steps:
- A thorough examination by your doctor is performed to check for any medical issues that need to be addressed prior to surgery.
- Depending on your medical history, social history, and age, you may need to undergo tests such as blood work and imaging to help detect any abnormalities that could threaten the safety of the procedure.
- You will be asked if you have allergies to medications, anesthesia, or latex.
- You should inform your doctor of any medications, vitamins, or supplements that you are taking.
- You should refrain from medications or supplements such as blood thinners, aspirin, or anti-inflammatory medicines for 1 to 2 weeks prior to surgery.
- You should refrain from alcohol or tobacco at least a week before and two weeks after surgery.
- You should not consume any solids or liquids at least 8 hours prior to surgery.
- You will be instructed to wash your hair with an antibacterial soap the morning of surgery to help lower your risk of infection after surgery.
- Arrange for someone to drive you Brain and Spine Center of Southern CA, Dr Sean Armin, Neurosurgeon, Spine Surgeon, San Fernando Valley, Los Angeles, Beverly Hills, CA as you will not be able to drive yourself after surgery.
- A written consent will be obtained from you after the surgical procedure has been explained in detail.
Procedure for Frame-Based and Image-Guided Stereotactic Resection
Frame-based and image-guided stereotactic resection is usually performed under general anesthesia and takes about 2 to 3 hours or longer. In general, the procedure involves the following steps:
- You will be asked to take off any jewelry, clothing, or other objects that may obstruct the procedure and wear a hospital gown.
- An intravenous (IV) line will be inserted into your hand or arm to provide medicines and fluids.
- A urinary catheter will be inserted to drain your urine.
- Your anesthesiologist will continuously monitor your vital signs throughout the surgery.
- You will be placed on the operating table in a way that gives your surgeon the best access to the side of the brain to be operated on.
- Your head will be shaved and the surgical site will be cleaned with an antiseptic solution.
- Your head will be held firmly in position by a 3-pin fixation device/skull clamp attached to the operating table throughout the surgery.
- The head is mounted with a frame and image guidance is used to register the head with infrared cameras to correlate the “real patient” to the three-dimensional computer model formed from the MRI or CT scans taken a day or two before the surgery. The system works like a GPS to assist your surgeon in planning the craniotomy and detecting the lesion.
- After detecting the precise location of the treatment area, your surgeon uses special instruments to make a small burr hole or keyhole incision, remove a section of the skull bone (bone flap), cut open the dura mater (outer covering of the brain), and access the treatment area in the brain. Special instruments used for surgery are detected by the cameras and displayed on the computer model. Your surgeon uses this image, along with instruments that guide exactly where your surgeon is in the brain in order to remove the targeted lesion.
- Your surgeon performs the required treatment such as removal of a deep-seated tumor, blood clot, abscess, or aneurysm accordingly.
- Once the treatment is complete, the instruments are removed, the layers of tissue are stitched together, and the bone flap is reattached using wires, plates, or sutures.
- The skin incision is finally closed with surgical staples or stitches, and a sterile dressing or bandage is applied to complete the operation.
Postoperative Care and Recovery
In general, postoperative care instructions and recovery after a frame-based and image-guided stereotactic resection will involve the following steps:
- You will be transferred to the recovery area where your nurse will closely observe you for any allergic/anesthetic reactions and monitor your vital signs as you recover. Frequent neurological checks will be performed by your medical staff to assess your brain function.
- Most patients may need to stay in the hospital for 2 to 3 days before discharge to Brain and Spine Center of Southern CA, Dr Sean Armin, Neurosurgeon, Spine Surgeon, San Fernando Valley, Los Angeles, Beverly Hills, CA.
- You may experience pain, inflammation, and discomfort in the operated area. Pain and anti-inflammatory medications are provided as needed.
- Application of cold and heat therapy on the operated area is also recommended to reduce inflammation and pain.
- Antibiotics are prescribed as needed to address the risk of surgery-related infection.
- Keep the surgical site clean and dry. Instructions on surgical site care and bathing will be provided.
- Refrain from smoking and alcohol for a specific period of time as it can negatively affect the healing process.
- Gentle neck stretches and regular walking is recommended to improve strength and endurance.
- Refrain from strenuous activities and lifting anything heavier than 5 pounds until the first follow-up visit. These activities include housework, yard work, gardening, mowing, etc.
- Gradual increase in activities over a period of time is recommended. You may take many weeks to return to your previous level of strength and energy.
- Refrain from driving until you are fully fit and receive your doctor’s consent.
- A periodic follow-up appointment will be scheduled to monitor your progress.
Risks and Complications
Frame-based and image-guided stereotactic resection is a relatively safe procedure; however, as with any surgery, some risks and complications may occur, such as:
- Blood loss
- Blood clots or deep vein thrombosis
- Anesthetic/allergic reactions
- Nerve damage
- Cerebrospinal fluid leakage
- Brain swelling
- Blood pressure fluctuation