Use of a frameless, armless stereotactic wand for brain tumor localization with two-dimensional and three-dimensional neuroimaging.

Preliminary experience with a frameless, armless stereotactic localization system in brain tumor surgery is presented. The localizing wand emits ultrasonic pulses that are detected by a table-mounted array of microphones--with triangulation of the emitter positions. The wand tip and trajectory are determined by proprietary computer software. Real-time display of this information is presented in multiple, two-dimensional or three-dimensional displays. Forty-eight patients underwent 52 craniotomies for brain tumors. The wand was used to assist in placing a minimal craniotomy in 48 cases, to determine the tumor/brain interface in 27 cases, to localize subcortical tumors in 14 cases, and to correlate the physiological mapping with the surface anatomy in 5 cases. In 12 instances, the wand was used in conjunction with frame stereotaxy and found to be comparable or superior. Triplanar (coronal, sagittal, transverse) two-dimensional images provided sufficient information for the detection of tumor boundaries but proved difficult to use to access a subcortical lesion; two-dimensional or three-dimensional images along the localization axis were more helpful. Frameless stereotaxy with this sonic wand system proved to be a useful adjunct to open-tumor biopsy or resection.