Flexibility of head positioning and head fixation provided by a novel system for non-invasive maxillary fixation and frameless stereotaxy: technical note.

ABSTRACT

OBJECTIVE: The aim of this study was to demonstrate the flexibility in patient positioning and head fixation provided by a newly developed, minimally invasive upper jaw fixation device in combination with standard navigation software. TECHNIQUE The Vogele-Bale-Hohner (VBH) headholder and the Stereotactic Intervention and Planning Laboratory (SIP-Lab) Innsbruck reference frame, were applied in epilepsy surgery requiring stereotactic guidance. The system can be adapted to various positioning and instrument guidance requirements. Instrument holders can be fixed either to a base plate or directly to the mouthpiece. When used together with a head clamp and a stabilizing arm, there are no restrictions on patient positioning. When used with the non-invasive headholder, only the supine position is well-suited for use with the described guidance instrumentation. The system can also be used with the head placed on the horseshoe headholder without altering navigation support. CONCLUSION: The VBH mouthpiece combined with an external registration frame is a flexible tool that permits patient positioning and neuronavigation with the head either fixed with a head clamp, or restrained non-invasively with a headholder, or not fixed at all. This might be advantageous within the context of epilepsy surgery.