PMC4970521_01
Cosman-Roberts-Wells (CRW) head frame used for rigid fixation to cranium for stereotactic neurosurgery. Frame is affixed to cranium via four screws placed through graphite posts (red arrows). Outer cage (black arrow) serves as a CT localizer for image registration.
fsurg-03-00044-g001.jpg
PMC4970521_01_fsurg-03-00044-g001.jpg
F1
The Cosman-Roberts-Wells (CRW) (Integra, Burlington, MA, USA) rigid stereotactic frame was placed over his head without the percutaneous screw fixation that would be required in the real setting (Figure 1).
Positioning of potential patient in CRW frame, prior to CT scanning.
fsurg-03-00044-g002.jpg
PMC4970521_01_fsurg-03-00044-g002.jpg
F2
The patient was then positioned in a supine position, with the CRW frame rigidly fixed to the bed (Figure 2).
Simulation of intraoperative CT scanning for image registration and DBS planning.
fsurg-03-00044-g003.jpg
PMC4970521_01_fsurg-03-00044-g003.jpg
F3
The intraoperative CT (Bodytom, Samsung) was then maneuvered into place, to provide G.B (Figure 3) with a realistic appreciation of the process.
Simulated patient perspective of presurgical positioning, situated from within the CRW frame, prior to draping.
fsurg-03-00044-g004.jpg
PMC4970521_01_fsurg-03-00044-g004.jpg
F4
The patient was able to experience a first-person perspective of his rigidly fixed visual field (Figure 4).
Surgical positioning after sterile draping. The sterile field is located behind the drape (not visualized), whereas the interactive patient space is located on the near side of the drape (visualized). This arrangement allows for the team to perform "awake" examination of the arms, legs, and face during deep brain stimulation.
fsurg-03-00044-g005.jpg
PMC4970521_01_fsurg-03-00044-g005.jpg
F5
Once the CT machine was removed, standard sterile prepping and draping was performed (Figure 5), recreating the "awake" spatial environment (Figure 6).
Simulated patient perspective, after sterile draping, during the DBS procedure. The patient may experience this viewpoint for 4-6 h, as the surgery is being performed.
fsurg-03-00044-g006.jpg
PMC4970521_01_fsurg-03-00044-g006.jpg
F6
Once the CT machine was removed, standard sterile prepping and draping was performed (Figure 5), recreating the "awake" spatial environment (Figure 6).