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The Changing Role of Stereotaxis in Surgical Neuro-Oncology
Mark E. Linskey
Department of Neurological Surgery, University of California, Irvine, UCI
Medical Centre, Orange, CA, USA
Purpose. Evaluate evolution and time course of stereotactic neurosurgery within
surgical neuro-oncology.
Methods.
MEDLINE search 1966–2003
sub-stratified and analyzed for annual trends.
AANS/CNS membership databases for
Joint Sections.
ACRC neuro-oncology program database 1998–2003.
Results.
Tumor stereotaxis emerged in 1980 and became the dominant stereotactic
publication topic by 1984.
Frame-based tumor stereotaxis led publications
through 1994, when supplanted by stereotactic radiosurgery (SR).
Brachytherapy
led SR 1982–1987,
but then fell behind, reducing to pre-1983 levels by 1996.
SR publications
currently comprise 65% of stereotactic tumor articles and publication rate
continues to rise at a steady rate.
Frameless stereotaxis (FS) publications
began to increase in 1993 and growth is larger than the corresponding fall in
frame-based volumetric resection publications.
Data suggest increased
utilization for cases that would have otherwise utilized ultrasound or gone
without image guidance.
Intraoperative MR developed predominantly as
complimentary technology to FS.
Tumor diagnostic needle biopsy publications
continue to be mostly frame-based, while FS techniques are largely resection
focused.
This may change as >80%
of our tumors biopsied with frame-based techniques would be candidates for FS
biopsy based solely on lesion size, location, and technique accuracy
considerations.
Conclusion.
The role of tumor stereotaxis in surgical neuro-oncology is important, but
changing.
SR is increasingly dominating the subspecialty.
Stereotactic tumor
resection has become a mainstream neurosurgical procedure due to FS, and this
will likely occur with needle biopsy as well.
Delivery of experimental therapies
remains predominantly frame-based, but may need to transition to FS in order to
gain wider mainstream acceptance and applicability once efficacy is
demonstrated.
Keywords: biopsy, brachytherapy, brain neoplasms, gliomas, radiosurgery, stereotaxis,
technology
Copyright
©
2004 Kluwer Academic Publishers.
All rights reserved
Source: http://ipsapp007.kluweronline.com/IPS/content/ext/x/J/5042/I/124/A/3/abstract.htm
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