Abstract
Introduction: Frame-based stereotaxis has been widely utilized for precise neurosurgical procedures throughout the world for nearly 40 years. The N-localizer is an integral component of most of the extant systems. Analysis of targeting errors related to the N-localizer has not been carried out in sufficient detail. We highlight these potential errors and develop methods to reduce them. Methods: N-localizer systems comprising three and four N-localizers of various geometries were analyzed using Monte Carlo (MC) simulations. The simulations included native and altered geometric dimensions (Width [W] x Height [H]). Errors were computed using the MC simulations that included the x- and y-axes of vertically oriented rods, that altered the W/H ratio, and that added a fourth N-localizer to a three N-localizer system. Results: The inclusion of an overdetermined system of equations and the geometries of the N-localizer systems had significant effects on target errors. Root Mean Square Errors (RMS-e) computed via millions of MC iterations for each study demonstrated that errors were reduced by (1) inclusion of the x- and y-coordinates of the vertically oriented rods, (2) a greater triangular area enclosed by the diagonal fiducials of the N-localizer system (stereotactic triangle), (3) a larger W/H ratio, and (4) an N-localizer system that comprised four N-localizers.Conclusion: Monte Carlo simulations of Root Mean Square error (RMS-e) is a useful technique to understand targeting while using N-localizer systems in stereotactic neurosurgery. The application of vertical rod positions enhances computational accuracy and can be performed on any N-localizer system. Keeping the target point within the stereotactic triangle enclosed by the diagonal rods can also reduce errors. Additional optimizations of N-localizer geometry may also reduce potential targeting errors. Further analysis is needed to confirm these findings which may have clinical importance.
Highlights
Frame-based stereotaxis has been widely utilized for precise neurosurgical procedures throughout the world for nearly 40 years
Root Mean Square Errors (RMS-e) computed via millions of Monte Carlo (MC) iterations for each study demonstrated that errors were reduced by (1) inclusion of the x- and ycoordinates of the vertically oriented rods, (2) a greater triangular area enclosed by the diagonal fiducials of the N-localizer system, (3) a larger W/H ratio, and (4) an N-localizer system that comprised four N-localizers
To explore the advantage of this inverted or antiparallel configuration, we evaluated a rectilinear 140x140 mm N-localizer system that comprises three N-localizers arranged in either standard or inverted configuration
Summary
Frame-based stereotaxis has been widely utilized for precise neurosurgical procedures throughout the world for nearly 40 years. Analysis of targeting errors related to the N-localizer has not been carried out in sufficient detail. We highlight these potential errors and develop methods to reduce them. Stereotactic space localization is a key step in the use of frame-based systems that provides coordinates for direct targeting in the brain. For this localization step, the N-localizer has been the most commonly used system for the past 40 years [1,2,3]. A careful and robust analysis of these systems may suggest improvements to the accuracy of the localization step, which may directly impact the targeting during the neurosurgical procedure. We analyzed various existing and theoretical N-localizer geometries
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