Leksell model g stereotactic frame

Manufactured by Elekta

Sourced in United States

The Leksell model G stereotactic frame is a medical device used for precise targeting and positioning of surgical instruments or probes within the human body. It is a three-dimensional coordinate system that allows for accurate localization of anatomical structures, enabling image-guided procedures and minimally invasive treatments.

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Gammaplan, by Elekta (1 mentions) Leksell surgiplan, by Elekta (1 mentions)

10 protocols using leksell model g stereotactic frame

Stereotactic Radiosurgery for Glossopharyngeal Neuralgia

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The models B, C, 4C, and Perfexion Gamma Knife units were used for SRS, depending on the technology available at participating centers. After application of the Leksell model G stereotactic frame (Elekta Instruments) while patients were under local anesthesia, usually supplemented by mild intravenous sedation, all patients underwent stereotactic MRI to identify the glossopharyngeal nerve. The MR studies were performed using contrastenhanced, short-repetition time sequences and axial volume acquisitions of 512 × 216 matrices divided into 1-mm slices. When the glossopharyngeal nerve was difficult to identify on images (usually because of previous surgery), additional axial long-relaxation time MR images were obtained. A single 4-mm isocenter was used for targeting the glossopharyngeal nerve at the level of the glossopharyngeal meatus (Fig. 2). In 1 patient, 2 isocenters were used to irradiate a longer nerve segment. The median maximum dose was 80 Gy (range 80-90 Gy). A team consisting of a neurosurgeon, radiation oncologist, and medical physicist performed dose selection and planning.

Kano H., Urgosik D., Liscak R., Pollock B.E., Cohen-Inbar O., Sheehan J.P., Sharma M., Silva D., Barnett G.H., Mathieu D., Sisterson N.D, & Lunsford L.D. (2016). Stereotactic radiosurgery for idiopathic glossopharyngeal neuralgia: an international multicenter study. Journal of neurosurgery, 125(Suppl 1).

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Stereotactic Radiosurgery for Pituitary Tumors

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GKRS was performed for patients with tumors smaller than 2.5 cm and associated mild symptoms. In addition, GKRS was performed in the setting of progression of known residual disease after STR or recurrence in the setting of previous GTR. Briefly, GKRS began with application of the Leksell model G stereotactic frame (Elekta AB) after administration of a local anesthetic. After frame placement, high-resolution stereotactic MRI was performed. Thin-slice axial images were obtained after intravenous contrast administration. Radiosurgical dose planning was then performed by the neurosurgeon (M.B.S.) in conjunction with a radiation oncologist (S.R.I. or T.J.C.W.) and a medical physicist. The median prescription dose was 14 Gy with a range of 12-16 Gy to the 50% isodose line. In general, the dose would be reduced based on considerations related to tumor volume, proximity to critical structures such as the brainstem, preexisting neurological deficits, and history of previous treatments with radiosurgery. The total volume of brainstem receiving 10 and 12 Gy was restricted to less than 0.1 cm 3 and 0.35 cm 3 , respectively. The dose to the optic nerve and chiasm was limited to a maximum dose of 8 Gy.

D'Amico R.S., Banu M.A., Petridis P., Bercow A.S., Malone H., Praver M., Wang T.J.C., Isaacson S.R, & Sisti M.B. (2017). Efficacy and outcomes of facial nerve-sparing treatment approach to cerebellopontine angle meningiomas. Journal of neurosurgery, 127(6).

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Gamma Knife Radiosurgery Protocol

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The Gamma Knife models U, B, C, 4C, and Perfexion were used depending on the technology available at the time of GKRS for each participating center. The radiosurgery procedure began with the application of the Leksell model G stereotactic frame (Elekta AB) using local anesthetic supplemented by additional sedation as needed. All radiosurgery procedures were performed in a single fraction. After stereotactic frame placement, high-resolution stereotactic MRI was performed. In cases in which MRI was not feasible or when MRI distortion was a concern, a stereotactic CT scan was obtained. Thin-slice axial and/or coronal images were obtained after intravenous contrast administration. Stereotactic cerebral angiography was performed, and the images were incorporated in treatment planning for nidus definition and dose planning. Radiosurgery dose planning was then performed by the neurosurgeon in conjunction with a radiation oncologist and medical physicist.

Starke R.M., McCarthy D.J., Chen C.J., Kano H., McShane B., Lee J., Mathieu D., Vasas L.T., Kaufmann A.M., Wang W.G., Grills I.S., Patibandla M.R., Cifarelli C.P., Paisan G., Vargo J.A., Chytka T., Janouskova L., Feliciano C.E., Rodriguez-Mercado R., Tonetti D.A., Lunsford L.D, & Sheehan J.P. (2019). Evaluation of stereotactic radiosurgery for cerebral dural arteriovenous fistulas in a multicenter international consortium. Journal of neurosurgery.

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Stereotactic Radiosurgery for Pituitary Adenomas

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Stereotactic radiosurgery for pituitary adenomas has been described previously [20 (link)]. Gamma Knife Models U, B, C, 4C, or Perfexion^® were used during the study period, depending on the technology available at the time for each participating center. The Leksell Model G stereotactic frame^® (Elekta AB, Stockholm, Sweden) was applied using local anesthetic supplemented with additional sedation as needed. A high resolution, volumetric T1-weighted MRI sequences were obtained with and without the administration of gadolinium. Thin-slice axial and/or coronal plane images were obtained after the intravenous contrast administration. The selection of dose to the pituitary adenoma was determined generally according to the status of the adjacent cranial nerve function, the size of the adenoma and the distance between the adenoma and adjacent critical structures, in particular the anterior optic pathways. Multidisciplinary radiosurgery dose planning was then performed by a neurosurgeon, a radiation oncologist, and a medical physicist.
In this series, the median margin dose delivered to the tumor margin were 14.5 (range 11–18) Gy in the SCAs group and 14 Gy (range 5–25) in the non-SCA group, and these were not significantly different between the groups (p = 0.814). Other radiosurgical parameters are detailed in Table 1.

Inbar O.C., Xu Z., Lee C.C., Wu C.C., Chytka T., Silva D., Sharma M., Radwan H., Grills I.S., Nguyen B., Siddiqui Z., Mathieu D., Morin C.I., Wolf A., Cifarelli C.P., Cifarelli D.T., Lunsford L.D., Kondziolka D, & Sheehan J.P. (2017). Prognostic significance of corticotroph staining in radiosurgery for non-functioning pituitary adenomas: a multicenter study. Journal of neuro-oncology, 135(1), 67-74.

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Deep Brain Stimulation Surgical Protocol

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Surgery was performed following our standard procedure protocol (Ma et al., 2017 ). In short, we performed a positioning MRI scan with Gadolinium-based contrast prior to surgery. These images are then fused with the Leksell Model G stereotactic frame (Elekta AB, Stockholm, Sweden) based on CT images acquired on the day of surgery. Microelectrode recording (MER) was conducted for intraoperative electrophysiological localization of subthalamic nucleus (STN) or globus pallidus internus (GPi) without sedative agents. The electrode placement was further confirmed via macro-stimulation. The IPG was then implanted into the subclavian pouch under general anesthesia. The electrodes were connected to the IPG through corresponding extension wires. The position of the electrodes was examined again in a postoperative CT review within 24 h.

Xu S., Wang W., Chen S., Wu Q., Li C., Ma X., Chen T., Li W, & Xu S. (2021). Deep Brain Stimulation Complications in Patients With Parkinson’s Disease and Surgical Modifications: A Single-Center Retrospective Analysis. Frontiers in Human Neuroscience, 15, 684895.

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Gamma Knife Radiosurgery Protocol

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The Gamma Knife models U, B, C, 4C, or Perfexion were used depending on the technology available at the time of the procedure for each participating center. The radiosurgery procedure began with the application of the Leksell model G stereotactic frame (Elekta AB) using a local anesthetic supplemented by additional sedation as needed. All radiosurgeries were performed in a single fraction. After stereotactic frame placement, stereotactic high-resolution MRI was performed. In cases in which MRI was not feasible or in which MRI distortion was a concern, stereotactic computed tomography scanning was conducted. Thin-slice axial and/or coronal images were obtained after intravenous contrast administration. Stereotactic cerebral angiography was conducted and incorporated in treatment planning for nidus definition and dose planning. Radiosurgery dose planning was then performed by the neurosurgeon in conjunction with a radiation oncologist and medical physicist.

Starke R.M., McCarthy D.J., Chen C.J., Kano H., McShane B.J., Lee J., Patibandla M.R., Mathieu D., Vasas L.T., Kaufmann A.M., Wang W.G., Grills I.S., Cifarelli C.P., Paisan G., Vargo J., Chytka T., Janouskova L., Feliciano C.E., Sujijantarat N., Matouk C., Chiang V., Hess J., Rodriguez-Mercado R., Tonetti D.A., Lunsford L.D, & Sheehan J.P. (2019). Hemorrhage risk of cerebral dural arteriovenous fistulas following Gamma Knife radiosurgery in a multicenter international consortium. Journal of neurosurgery.

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Stereotactic GKRS for AVM Evaluation

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The GKRS technique used at each contributing center has been previously described. 44 In brief, a Leksell model G stereotactic frame (Elekta AB) was applied to the patient's cranium under anesthesia. The angioarchitecture of the AVM nidus was assessed with thin-slice MRI (typical slice width approximately 1 mm) and cerebral angiography. Thin-slice CT was obtained in patients who were unable to undergo MRI or prior to availability of MRI. In the early era prior to CT, cases were planned using biplanar cerebral angiography alone. Dose planning including target delineation, defining of critical structures potentially at risk, and dose selection was performed by a multidisciplinary team consisting of a radiation oncologist, medical physicist, and neurosurgeon.

Patibandla M.R., Ding D., Kano H., Starke R.M., Lee J.Y.K., Mathieu D., Whitesell J., Pierce J.T., Huang P.P., Kondziolka D., Feliciano C., Rodriguez-Mercado R., Almodovar L., Grills I.S., Silva D., Abbassy M., Missios S., Barnett G.H., Lunsford L.D, & Sheehan J.P. (2018). Effect of treatment period on outcomes after stereotactic radiosurgery for brain arteriovenous malformations: an international multicenter study. Journal of neurosurgery, 130(2).

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Gamma Knife Radiosurgery Protocol

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The radiosurgical techniques used herein have been previously described [25 (link),26 (link),27 (link)]. GKS was performed following administration of a local anesthetic agent. After a Leksell model G stereotactic frame (Elekta AB) was affixed to the head, each patient underwent stereotactic MRI to identify the tumor. High-resolution, thin-slice (1 mm), post-contrast T1- and T2-weighted brain MRI scans were obtained and used for stereotactic targeting. Targeting was based on axial images. These imaging sequences provide a graphic depiction of the optic nerve, brain stem, and tumor. Treatment planning was performed using the Leksell GammaPlan software (version 5.32) for the C Gamma Knife (Elekta AB) model. The target volumes were drawn in the presence of a neuroradiologist, neurosurgeon, and physicist. Each treatment plan was created using the same clinical criteria: a plan that was as conformal as possible without exceeding the dose constraints for critical structures. The plug function was used to protect the critical structures.

Chu S.A., Chen T.B., Chen H.J., Wang K.W., Chen J.S., Chuang F.C., Wang H.K, & Liang C.L. (2022). Gamma Knife Radiosurgery as a Salvage Treatment for Nasopharyngeal Carcinoma with Skull Base and Intracranial Invasion (T4b). Life, 12(11), 1880.

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Stereotactic MRI-Guided Deep Brain Stimulation

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The surgery was done in two stages. The first stage involves implantation of the DBS electrodes under local anesthesia. Procedure starts with application of Leksell stereotactic frame Model G (Elekta Instruments, Atlanta, GA, USA) to the patient’s head.
A high-resolution MRI of the patient’s brain with a 3 Tesla scanner (Signa 3T94 VHi; General Electric Medical Systems, Milwaukee, WI, USA) was done. Two main sequences were obtained. The first is a 3D T1-weighted, spoiled gradient echo imaging of the entire head (section thickness: 2 mm; field of view: 26 × 26 cm; TR: 7.0–8.0 milliseconds; TE: ~400 milliseconds; flip angle: 12; band width: 31.25 KHz; acquisition time: <7 min). The second is high-resolution, contiguous, T2-weighted, fast spin-echo imaging through the region of the midbrain and basal ganglia (section thickness: 1.5 mm; slice interval: 0 mm; matrix size: 512 × 512; field of view: 26 × 26 cm; TR: 4600–6200 milliseconds; TE: 95–108 milliseconds; acquisition time: <5 min) (Figure 1).

Rabie A., Verhagen Metman L, & Slavin K.V. (2016). Using “Functional” Target Coordinates of the Subthalamic Nucleus to Assess the Indirect and Direct Methods of the Preoperative Planning: Do the Anatomical and Functional Targets Coincide?. Brain Sciences, 6(4), 65.

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Stereotactic Biopsy Procedure for CNS Tumors

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Tissue samples were immediately fixed in 10% formalin solution and sent to the Pathology Department, where they were processed the same day or the day after in cases in which the procedures were performed in the late afternoon. Histopathological diagnosis was performed according to the 2016 WHO classification of CNS tumours [45 (link)]. In cases of stereotactic biopsy, the procedure began with fixation of the patient’s skull in the MRI-compatible Leksell stereotactic frame (Model G, Elekta, Stockholm, Sweden). During the procedure, a Sedan biopsy needle (10 mm needle window, 2.5 mm diameter) was used to acquire at least two cylindrical tissue biopsies, based on the macroscopical aspect, size of the sample, and procedure-related risks. The bioptic sampling accuracy was eventually confirmed via co-registering the postoperative CT images with preoperative imaging and the planned trajectory in the Leksell SurgiPlan^® (Elekta Instruments AB, Stockholm, Sweden) software for all cases in the series. The stereotactic coordinates of the exact, final sites of biopsy were exported from the Surgiplan software and transferred to VERDICT maps using the transformations obtained when registering the T1-weighted images to dMRIs.

Figini M., Castellano A., Bailo M., Callea M., Cadioli M., Bouyagoub S., Palombo M., Pieri V., Mortini P., Falini A., Alexander D.C., Cercignani M, & Panagiotaki E. (2023). Comprehensive Brain Tumour Characterisation with VERDICT-MRI: Evaluation of Cellular and Vascular Measures Validated by Histology. Cancers, 15(9), 2490.

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