Neurosurgical approaches to therapeutic brain stimulation for treatment-resistant depression.

During the 1940s and 1950s, psychosurgery was used for the treatment of severe mental disorders but was associated with significant complications. These problems and the advent of psychotropic drugs led to a decline in the use of psychosurgery. Neuroanatomical and brain imaging studies have revealed distinct brain regions and the pathways that connect them, which may underlie depression and other mental disorders. On the basis of this knowledge, modern stereotactic neurosurgical methods have been used to implant electrodes in the brain to provide therapeutic stimulation. Electrical stimulation by these electrodes with pacemaker-like devices can be used to modulate brain function by stimulating or inhibiting the activity of specific brain regions, without causing permanent or destructive lesions that cannot be reversed. Deep brain stimulation and cortical brain stimulation are two such neurosurgical approaches to therapeutic brain stimulation for treatment-resistant depression.

Exploring frameless stereotactic image guided surgery.

Frameless stereotactic image guided surgery (IGS)--a fairly new modality originally used in cranial neurosurgical procedures--has been found to have several advantages over traditional framed methods of three-dimensional navigation. Frameless stereotactic IGS is proving useful in neurosurgical procedures by allowing screws to be placed in the spine more quickly and accurately than with traditional methods. As IGS becomes standard clinical practice for certain spinal procedures--overlapping both neurosurgery and orthopedic specialties--new ideas for surgical application of the technology are developing. Currently, frameless stereotactic IGS is being investigated for use in hardware placement in orthopedic procedures and for endoscopic navigation in otorhinolaryngologic sinus procedures. Frameless stereotactic IGS is expected to gain application approval in both orthopedic and otorhinolaryngologic specialties from the US Food and Drug Administration in the near future.

New instrumentation allows for removal of nonpalpable breast lesions.

Breast cancer is the second leading cause of cancer deaths in women. Approximately 90% of breast cancer is curable if it is diagnosed and treated early. Increasingly, women are participating in mammographic screenings, which result in earlier detection of nonpalpable lesions. In the past, surgical removal was not an option for small lesions, and frequent mammographic monitoring was required until patients' lesions were large enough for needle core biopsies or needle localization for open surgical biopsies. Technology now has combined stereotactic imaging with a minimally invasive biopsy system for removal of these nonpalpable lesions. This capability for accurate early diagnosis and intervention is essential in improving patients' survival rates.

Stereotactic biopsy procedures for brain tumor diagnosis.

Stereotactic biopsy procedures, in which a computer-based, three-dimensional-image-guided system accurately locates patients' brain tumors, are relatively new diagnostic methods. Complications from stereotactic biopsy procedures are minimal compared with open craniotomy procedures because they are performed with local anesthesia. Perioperative nurses should have knowledge of and be trained in stereotactic biopsy procedures to ensure optimal care for patients undergoing these procedures.

Stereotactic pallidotomy for treatment of Parkinson's disease.

There has been a resurgence of interest in surgical treatment of Parkinson's disease in the past five years due to the large number of patients who have medically intractable symptoms and because significant improvements in neuroimaging and stereotactic techniques have made surgical procedures safer and more accurate. Stereotactic pallidotomy procedures allow neurosurgeons to destroy a portion of the globus pallidus, and thereby, decrease patients' muscle rigidity from Parkinson's disease. These surgical procedures primarily involve magnetic resonance-guided stereotactic targeting and microelectrode recording techniques. To ensure successful patient outcomes, stereotactic pallidotomy procedures require special perioperative nursing interventions discussed in this article.

Interactive, image-guided, stereotactic neurosurgery systems.

Interactive, image-guided, stereotactic neurosurgery systems and advanced computer programs enable neurosurgery teams to use magnetic resonance imaging (MRI) and computed tomography (CT) scans to perform less-invasive intracranial tumor excisions. This new methodology, also known as frameless stereotactic neurosurgery, provides accurate, precise preoperative and intraoperative patient information to neurosurgeons. Neurosurgeons use a pointing device to communicate surgical locations quickly to a computer system. The computer then provides immediate, three-dimensional displays of pertinent MRI and CT scan information on the monitor. These intracranial images serve as navigational guides to neurosurgeons before and during surgical intervention. Interactive, image-guided, stereotactic neurosurgery systems, however, are only surgical tools, not substitutes for health care providers' knowledge or expertise. Neurosurgeons must balance their medical judgment with interpretations of computer-generated information throughout the surgical procedures. Interactive, image-guided systems should not interfere with patient care priorities but rather should be worked into the intraoperative nursing routine.