Frameless Functional Stereotactic Approaches

The stereotactic frame has served as the gold standard apparatus for accurate and precise targeting of deep brain structures since 1947. Despite passing the test of time, the stereotactic frame has several limitations from the perspective of both neurosurgeons and patients. Therefore, there was a need to develop a frameless system that had equivalent accuracy and reliability to the frame. This need was met with 3 commercially available frameless stereotactic systems designed specifically for deep brain stimulation surgery: Nexframe, STarFix, and ClearPoint. Over the past decade, the frameless and frame-based systems have been extensively investigated by numerous studies and found to be equivalent in experimental and clinical accuracy as well as in clinical outcomes. This chapter summarizes the findings of those studies along with the discussion of sources of stereotactic errors. The procedural aspects, advantages, and disadvantages of each frameless system are reviewed. Frameless stereotaxy is a safe, accurate, and effective technique for functional stereotactic approaches and provides a viable alternative to the frame-based systems.