Medicine:N-localizer

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N-localizer
Photograph of Stereotactic Frame With 3 N-localizers.jpg
Three N-localizers attached to a stereotactic frame.[1]
Specialtyneurosurgery, radiation oncology
Interventionstereotactic surgery, radiosurgery
Inventor(s)Russell A. Brown[2]

The N-localizer[3] is a device that enables guidance of stereotactic surgery or radiosurgery using tomographic images that are obtained via computed tomography (CT),[4] magnetic resonance imaging (MRI),[5] or positron emission tomography (PET).[6] The N-localizer comprises a diagonal rod that spans two vertical rods to form an N-shape (Figure 1) and permits calculation of the point where a tomographic image plane intersects the diagonal rod. Attaching three N-localizers to a stereotactic instrument allows calculation of three points where a tomographic image plane intersects three diagonal rods (Figure 2). These points determine the spatial orientation of the tomographic image plane relative to the stereotactic frame.[7]

The N-localizer is integrated with the Brown-Roberts-Wells (BRW),[8] Kelly-Goerss,[9] Leksell,[10] Cosman-Roberts-Wells (CRW),[11] Micromar-ETM03B, FiMe-BlueFrame, Macom, and Adeor-Zeppelin[12] stereotactic frames and with the Gamma Knife radiosurgery system.[13]

An alternative to the N-localizer is the Sturm-Pastyr localizer that comprises three rods wherein two diagonal rods form a V-shape and a third, vertical rod is positioned midway between the two diagonal rods (Figure 3).[14] The Sturm-Pastyr localizer is integrated with the Riechert-Mundinger and Zamorano-Dujovny stereotactic frames.[15]

Compared to the N-localizer, the Sturm-Pastyr localizer is less accurate and necessitates more elaborate calculations to determine the spatial orientation of the tomographic image plane relative to the stereotactic frame.[16] In contrast to the N-localizer that does not require specification of the pixel size in a tomographic image,[17] the Sturm-Pastyr localizer requires precise specification of the pixel size.[18]

Research conducted four decades after the introduction of the N-localizer[19] and Sturm-Pastyr localizer[20] has revealed computational techniques that improve the accuracy of both localizers.

Figures

  • Figure 1. Depiction of the N-localizer and its intersection with the tomographic image plane. (A) Side view of the N-localizer. The tomographic image plane intersects two vertical rods and one diagonal rod. (B) Tomographic image. The intersection of the tomographic image plane with the N-localizer creates two fiducial circles and one fiducial ellipse. The relative spacing between the ellipse and the two circles varies with the height at which the tomographic image plane intersects the diagonal rod.

  • Figure 2. Depiction of three N-localizers and their intersection with the tomographic image plane. The quadrilateral represents the tomographic image plane. The oval and the arch represent the stereotactic instrument. The vertical and diagonal lines attached to the oval represent three N-localizers. The three points where the tomographic image plane intersects the diagonal rods are depicted by the dots. These points of intersection determine the spatial orientation of the tomographic image plane relative to the stereotactic frame.

  • Figure 3. Depiction of the Sturm-Pastyr localizer and its intersection with the tomographic image plane. (A) Side view of the Sturm-Pastyr localizer. The tomographic image plane intersects two diagonal rods and one vertical rod. (B) Tomographic image. The intersection of the tomographic image plane with the Sturm-Pastyr localizer creates two fiducial ellipses and one fiducial circle. The relative spacing between the circle and the two ellipses varies with the height at which the tomographic image plane intersects the vertical rod.

References

  1. ↑ Arle, J (2009). "Development of a Classic: The Todd-Wells Apparatus, the BRW, and the CRW Stereotactic Frames". in Lozano, AM; Gildenberg, PL; Tasker, RR. Textbook of Stereotactic and Functional Neurosurgery. Berlin: Springer-Verlag. pp. 456–460. doi:10.1007/978-3-540-69960-6. ISBN 978-3-540-69959-0. 
  2. ↑ "System Using Computed Tomography as for Selective Body Treatment". U.S. Patent 4608977. 1986. 
  3. ↑ Galloway, RL Jr. (2015). "Introduction and Historical Perspectives on Image-Guided Surgery". in Golby, AJ. Image-Guided Neurosurgery. Amsterdam: Elsevier. pp. 2–4. doi:10.1016/B978-0-12-800870-6.00001-7. ISBN 978-0-12-800870-6. 
  4. ↑ "CT-guided stereotactic neurosurgery: experience in 24 cases with a new stereotactic system". Journal of Neurology, Neurosurgery & Psychiatry 47 (1): 9–16. 1984. doi:10.1136/jnnp.47.1.9. PMID 6363629. 
  5. ↑ "Brown-Roberts-Wells stereotactic frame modifications to accomplish magnetic resonance imaging guidance in three planes". Applied Neurophysiology 50 (1–6): 143–152. 1987. doi:10.1159/000100700. PMID 3329837. 
  6. ↑ "Positron emission tomography imaging-directed stereotactic neurosurgery". Stereotactic and Functional Neurosurgery 58 (1–4): 134–140. 1992. doi:10.1159/000098986. PMID 1439330. 
  7. ↑ Gildenberg, PL; Krauss, JK (2009). "History of Stereotactic Surgery". in Lozano, AM; Gildenberg, PL; Tasker, RR. Textbook of Stereotactic and Functional Neurosurgery. Berlin: Springer-Verlag. pp. 23. doi:10.1007/978-3-540-69960-6. ISBN 978-3-540-69959-0. 
  8. ↑ "Preliminary experience with Brown-Roberts-Wells (BRW) computerized tomography stereotaxic guidance system". Journal of Neurosurgery 59 (2): 217–222. 1983. doi:10.3171/jns.1983.59.2.0217. PMID 6345727. 
  9. ↑ "A computed tomography stereotactic adaptation system". Neurosurgery 10 (3): 375–379. 1982. doi:10.1227/00006123-198203000-00014. PMID 7041006. 
  10. ↑ "Stereotaxis and nuclear magnetic resonance". Journal of Neurology, Neurosurgery & Psychiatry 48 (1): 14–18. 1985. doi:10.1136/jnnp.48.1.14. PMID 3882889. 
  11. ↑ "Initial experience related to the Cosman-Roberts-Wells stereotactic instrument. Technical note". Journal of Neurosurgery 72 (1): 145–8. 1990. doi:10.3171/jns.1990.72.1.0145. PMID 2403588. 
  12. ↑ "Coordinate systems for navigating stereotactic space: how not to get lost". Cureus 12 (6): e8578. 2020. doi:10.7759/cureus.8578. PMID 32670714. 
  13. ↑ Tse, VCK; Kalani, MYS; Adler, JR (2015). "Techniques of Stereotactic Localization". in Chin, LS; Regine, WF. Principles and Practice of Stereotactic Radiosurgery. New York: Springer. pp. 25–32. doi:10.1007/978-1-4614-8363-2. ISBN 978-1-4614-8362-5. 
  14. ↑ "Stereotactic computer tomography with a modified Riechert-Mundinger device as the basis for integrated stereotactic neuroradiological investigations". Acta Neurochirurgica 68 (1–2): 11–17. 1983. doi:10.1007/BF01406197. PMID 6344559. 
  15. ↑ Krauss, JK (2009). "The Riechert/Mundinger Stereotactic Apparatus". in Lozano, AM; Gildenberg, PL; Tasker, RR. Textbook of Stereotactic and Functional Neurosurgery. Berlin: Springer-Verlag. pp. 487–493. doi:10.1007/978-3-540-69960-6. ISBN 978-3-540-69959-0. 
  16. ↑ "Comparative accuracies of the N-localizer and Sturm-Pastyr localizer in the presence of image noise". Cureus 12 (7): e9137. 2020. doi:10.7759/cureus.9137. PMID 32685325. 
  17. ↑ "A CT-based computerized treatment planning system for I-125 stereotactic brain implants". International Journal of Radiation Oncology, Biology, Physics 18 (2): 445–454. 1990. doi:10.1016/0360-3016(90)90114-Y. PMID 2406230. 
  18. ↑ "An algorithm for stereotactic localization by computed tomography or magnetic resonance imaging". Physics in Medicine and Biology 46 (1): N1–N7. 2001. doi:10.1088/0031-9155/46/1/401. PMID 11197682. 
  19. ↑ "Monte Carlo simulation of errors for N-localizer systems in stereotactic neurosurgery: novel proposals for improvements". Cureus 13 (2): e13393. 2021. doi:10.7759/cureus.13393. PMID 33758694. 
  20. ↑ "Improved accuracy for the Sturm-Pastyr localizer in the presence of image noise". Cureus 13 (9): e17905. 2021. doi:10.7759/cureus.17905. PMID 34660100. 

Further reading

  • Saleh, H; Kassas, B (2014). "Developing Stereotactic Frames for Cranial Treatment". in Benedict, SH; Schlesinger, DJ; Goetsche, SJ et al.. Stereotactic Radiosurgery and Stereotactic Body Radiation Therapy. Boca Raton: CRC Press. pp. 156–159. doi:10.1201/b16776. ISBN 978-1-4398-4198-3. 



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