Stereotactic Surgery - History

History

The stereotactic method was first developed by two British scientists in 1908, working at University College London Hospital, Sir Victor Horsley, a physician and neurosurgeon, and Robert H. Clarke, a physiologist. The Horsley–Clarke apparatus they developed was used for animal experimentation and implemented a Cartesian (three-orthogonal axis) system. Improved designs of their original device came into use in the 1930s for animal experimentation and are still in wide use today in all animal neuroscience laboratories.

Using the Horsley–Clarke apparatus for human brains was difficult because of the inability to visualize intracranial anatomic detail via radiography. However, contrasted brain radiography (particularly pneumoencephalography and ventriculography) permitted the visualization of intracranial anatomic reference points or landmarks. The first stereotactic devices for humans used the pineal gland and the foramen of Monro as landmarks. Later, other anatomic reference points such as the anterior and posterior commissures were used as intracranial landmarks. These landmarks were used with a brain atlas to estimate the location of intracranial anatomic structures that were not visible in radiographs.

Using this approach between 1947 and 1949, two American neurosurgeons, Ernest A. Spiegel and Henry T. Wycis, and a Swedish neurosurgeon, Lars Leksell, developed the first stereotactic devices that were used for brain surgery in humans. Spiegel and Wycis used the Cartesian coordinate system (also called the translational system) for their device. Leksell's device used the polar coordinate system (also called spherical) that was far easier to use and calibrate in the operating room. The stereotactic localization system was also used by Leksell in his next invention, a device for radiosurgery of the brain. This system is also used by the Gamma Knife device, and by other neurosurgeons, using linear accelerators, proton beam therapy and neutron capture therapy. Lars Leksell went on to commercialize his inventions by founding Elekta.

In 1978, Russell A. Brown, an American physician and computer scientist, invented a simple technique to guide stereotactic surgery using computed tomography. This technique significantly improves surgical precision because computed tomography permits direct visualization of intracranial anatomic detail. The technique uses fiducials to create extracranial landmarks in each tomographic image or section. These landmarks specify the spatial orientation of that section with respect to the stereotactic device. Brown's invention stimulated intense interest in stereotaxy and radiosurgery. It is widely used today in the Brown-Roberts-Wells (BRW) stereotactic system as well as other stereotactic and radiosurgical devices.

The stereotactic method has continued to evolve, and at present uses an elaborate mixture of image-guided surgery using computed tomography, magnetic resonance imaging and stereotactic localization.