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The application of nuclear magnetic resonance (NMR) imaging to a stereotactic method is described. The physical properties of NMR offer some important advantages such as good contrast between grey and white matter and the possibility to scan the brain in three planes and at any desired angle. Stereotactic localisation by NMR gives very satisfactory and precise visualisation of the target structures based on transaxial, coronal and sagittal scans. With the technique described stereotactic localisation is performed by the surgeon directly in the operating room.

The role of sodium concentration of the cerebrospinal fluid (CSF[Na]) in the initiation and/or satiation of Na appetite of Na-deplete or Na-replete sheep was investigated. Slow infusion (1 ml/h) into a lateral brain ventricle of an artificial sheep CSF solution was begun 0-60 min prior to and continued until the end of the Na access period (30-120 min). In Na-deficient sheep, increasing CSF[Na] caused a decrease in Na intake. In both Na-deficient and Na-replete sheep, decreasing CSF[Na] caused an increase in Na intake. The appetite was observed within 25 min of beginning infusion, which represents the most rapid induction of Na appetite yet observed. In Na-replete sheep, the appetite induced by decreasing CSF[Na] was predominantly for Na-containing solutions. A decrease in CSF[Na] of only 4-6 mmol/l was sufficient to induce Na appetite. The results derived by use of different Na, saccharide, or urea containing artificial CSF solutions suggest that there are sensors within the neuropil that respond to change of [Na] and influence salt appetite. They can be accessed by inducing change in [Na] of cerebroventricular CSF.

The development and scope of stereotactic radiosurgery is described. The technique, which combines well with the latest diagnostic methods, has already proved a safe and effective way of treating inaccessible cerebral lesions and in particular small arteriovenous malformations, acoustic neuroma and the solid component of craniopharyngioma, as well as playing an increasingly useful role in the therapy of pituitary adenoma.

A method for stereotactic coordinate determination by means of X-ray tomography is presented. A standard stereotactic method has been slightly modified, and the localization procedure has been adapted to CT scanning as well as conventional tomography. The technique allows rapid and accurate determination of the instrument coordinates of the target by the surgeon and may be used in conjunction with any standard CT body scanner or X-ray tomograph.

A device is presented that permits several applications for the Leksell stereotaxic system. The patient is fixed in this new system by means of a rectangular instrument that connects to the standard Leksell stereotaxic coordinate frame and maintains spatial orientation after the frame itself is removed. Specific uses for this device include stereotaxic radiosurgery and stereotaxic guidance during microsurgery. Other attractive features of this device are its capability of being precisely reapplied, its compatibility with both computerized tomography and magnetic resonance imaging, and the availability of an accessory device to adapt it for animal stereotaxis.

The ability to visualise stereotactic brain lesions produced by irradiation from the stereotactic Gamma Unit at the Karolinska Hospital was investigated. A patient who had undergone bilateral stereotactic gamma capsulotomy in two stages was examined by the nuclear magnetic resonance imaging technique, which demonstrated that the stereotactic lesions in the internal capsule could be visualised in the immediate postoperative period. This gives stereotactic radiosurgery a reliable anatomical basis and facilitates the planning and follow-up studies in this type of cerebral surgery.

Specimens from a number of patients locally irradiated in the thalamus for intractable pain with a multiple gamma beam technique have been examined. The geometry of well circumscribed necrotic lesions was ascertained. No correlation was seen between the dimensions of the lesions and the size of the field, 3 mm X 5 mm or 3 mm X 7 mm, within the clinically useful dose range, 16 to 25 krad.

Thalamotomy aiming at the CM-Pf complex and using stereotactic gamma irradiation has been performed in a series of 52 patients with severe pain due to malignancy. Lesions were produced either contra- or ipsilaterally to the side of the pain as well as bilaterally. Eight patients experienced good pain relief, 18 had moderate relief, and in 24 the operation did not significantly influence the pain. A second operation following recurrence of pain was rarely of value. There was a tendency towards more efficient relief of pain located in the face or in the arm and shoulder than of pain in the lower part of the body. Although contralateral lesions seem to be most effective, ipsilateral operations may also give some relief. The best results were obtained when the lesions were placed close to the wall of the third ventricle and at the level of the posterior commissure. Postmortem examination of 21 brains disclosed that the mean error in the placing of the lesions was about 1 mm. It is concluded that medial thalamotomy may be tried as a last resort in the treatment of cancer pain in selected patients with a short life expectancy.

The necessity for intraoperative computer tomographic (CT) visualization of stereotactic probes and for the immediate assessment of the results of therapeutic intervention has brought about the integration of CT and stereotactic surgical sites. In order to perform intraoperative CT imaging, a simple mechanical device has been developed to hold a probe at the target. This device replaces the conventional semicircular arc that was used to guide the probe to the target during stereotactic procedures. Intraoperative imaging during a CT stereotactic procedure was accomplished without significant artifacts.