Notice

This paper has been designed to resolve certain problems we faced in our work in the neurosciences hospital. We did not receive any financial support from any company mentioned in this paper.

Introduction

The Leksell Frame (Elekta, Sweden) is widely used for functional neurosurgical operations. For the proper application of the frame on the patients head; it is provided with ear plugs .these will prevent side way movement but it is quite painful & cannot be tolerated actually with all our patients. Also it will not prevent the foreword backward slipping of the frame. (₂, ₃) The frame is provided with head clamp compatible with only the Mayfield head holder (SM, USA) (₁); making it unadoptable with the head frames like the sugita head frame (Mizuho, Japan); the only sort of head frame we have in our hospital.

Patients& methods

In late 2007 & early 2008 we used these techniques for fifteen patients. Nine had deep brain stimulation (DBS) of the subthalamic nucleus for Parkinson's disease; one patient had DBS of the ventral intermediate nucleus for rubral tremor. One patient had DBS of the Globous pallidus internus nucleus for Dystonia. One patient had stereotactic removal of tuberculomas using the Steiner Lindquist laser guide (Elekta, Sweden); the last three patients it was used for stereotactic biopsy of deeply seated brain tumors.

The Leksell frame fixation is usually done in the radiology department. The head frame holder is composed of three straps sewed together to hold the temporal & occipital bars of the frame. The top of each strap is connected with plastic cup to fit firmly to the head & prevents its slipping by its suction ability over a well shaved head. Each one of them is sewed in its end with a tag to allow readjustment of the frame on the head. The straps on the temporal bars composed of two pairs to let an opening to observe the external auditory meatus; this is needed to align the frame along the canthomeatal line. We apply it of the patients head & fit the frame within its multi adhesive tags. The alignment of the frame can be readjusted frequently until we fix the pins & remove the straps. These straps didn't cause any pain or discomfort as the ear plug did to all the patients. They also prevent unwanted wide movement or slipping of the frame. Figures (1, 2, 3)

Figure 1

Figure 1: The five straps sewed together, they are connected in their ends with tags to adjust its length.

Figure 2

Figure 2: The straps applied to the leksell frame on both temporal bars ( two ribbons on each side) & the occipital one.

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In the operating theatre in order to apply the leksell frame to the sugitta head frame, we took the middle piece of the head holder. We removed the central slide adjusting screw& change it with a longer one with a knob that is usually available in the intravenous fluids (i.v.) stand. The paramedian screws exchanged with another longer ones. Figures (4, 5, 6)

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The Cognave of the leksell clamp is attached to the outer surface of the sugitta middle piece head holder. The long knob of the i.v. stand will connect both of them together& the lateral screws will help to prevent its movement by the engagement with the teeth of the Cognave. Figures (7, 8)

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Results

During its use no pain or discomfort were noticed on our patients .The frame fixed firmly to the table attachment of the sugitta head frame. No movement was noticed during the whole procedures between the operating table & the frame even in those DBS cases were the surgery with the frame applied to the patient extended for 8 hours. Figures (9, 10)

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Discussion

These technical modifications were important in our practice to facilitate the application of the frame over the head with minimal movement & shorter time. Although it may resemble that of the CRW frame (Radionics, USA) put the design is different & the slipping is much less than that with CRW frame. The adapter we made to fit the Leksell frame to the sugita was quite useful especially we not have the Mayfield head clamp in our hospital.

Conclusion

These two modifications are good alternatives to replace the ear plug which is quite painful for many patients& it will make those centers that have only the sugitta head frame to use it with the leksell stereotactic frame.

Correspondence to

Moneer K. Faraj, M.D., F.I.C.S. Chief Dept. of Neurosurgery Hospital of Neurosciences P.O.BOX 8148, salihiyia Baghdad 12222 Baghdad, Iraq Tel. 009647905599944 E-mail: drmkfaraj@yahoo.com