Principles of Safe Stereotactic Trajectories

Stereotactic planning plays a pivotal role in various neurosurgical procedures including deep brain stimulation (DBS), depth electrode placement, and stereoencephalography (sEEG) for intracranial monitoring in patients with epilepsy, responsive neurostimulation (RNS), laser interstitial thermal therapy (LITT), and biopsies. Presurgical planning is essential to success. This requires a thorough knowledge of clinical presentation, medical history, risk factors, results of preoperative studies, and possible benefits and hazards of surgery. Integration of this knowledge with an understanding of key principles of trajectory planning allows for deep structures of the brain to be approached safely.