Handbook of Stereotactic and Functional Neurosurgery PDF

Preface

The Latin derivation of ‘‘stereotaxy'' refers to a system in physical space; the term ‘‘stereotactic'' means to touch in space. Both concepts apply well to the expanding field of stereotactic neurosurgery. The history of stereotaxis began with the development of the experimental Horsley-Clarke apparatus in 1908. The adaptation of this system by Spiegel and Wycis in the 1940s spurred the growth of functional stereotactic surgery, which was used primarily for the treatment of patients with parkinsonism. With the advent of L-dopa in the late 1960s, stereotactic surgery became a relatively obscure part of neurosurgical training and practice, limited to a few centers.

Digital sectional imaging-computed tomography and then magnetic resonance imaging—has fueled a renaissance in stereotaxis, and then some. In the last 15 years, for instance, stereotactic biopsy has gone from being a ‘‘high-tech'' procedure reserved for academic institutions to a routine part of daily neurosurgery. The incorporation of frameless stereotaxy has been even more rapid. Radiosurgery, a subject that at first drew little interest (mostly negative) at major meetings, is now performed at hundreds of sites in the United States and is discussed avidly in large international forums.

Functional stereotaxy has made a comeback as well, as the limitations of chronic medical therapy for parkinsonism became apparent and the surgical technology improved. The advent of implantable stimulators has made nonablative functional stereotactic surgery a realistic possibility for community neurosurgeons. In part, this and other technological advances have spurred interest in surgery for patients with other movement disorders, pain, spasticity, and epilepsy.

Several excellent textbooks now provide detailed descriptions of the underlying theory and outcomes for the various subsets of stereotactic procedures. Perhaps because of their heft, however, they have not served as a practical guide for neurosurgeons. This book hopes to address that need. It is meant as an adjunct to the above-mentioned textbooks and monographs, which contain important information that any stereotactic neurosurgeon must thoroughly understand. A handbook such as this reflects the ongoing development of stereotaxis as part of every neurosurgeon's treatment arsenal.