inomed continues the tradition of

uncompromising precision in stereotactic tools

Inomed Stereotactic-systems-2

Modern functional neurosurgery procedures are now so minimally invasive that they have to be planned and performed with the highest degree of precision. The inomed stereotactic systems are defined by their reliability, precision and stability in their overall function. The fact that the work of the surgeon and the OR team is so simplified – because inomed’s systems are so easy to operate – is one of the qualities of inomed’s stereotactic systems that our customers appreciate most.

To date, there are no other systems on the market that are more convenient or have higher precision than the stereotactic systems created by inomed. The following reasons will help to explain why.

The ring-based stereotactic system used by inomed provides the highest level of stability. The basic physical properties of a ring are superior to all other basic geometric shapes in terms of strength and tolerance. This basic design element of the system and structure avoids common sources of error.

inomed stereotactic systems are the only systems worldwide with an advanced target point simulator. With the inomed target point simulator, theoretical planning from the planning software tools can be measured and verified according to the real-world geometric environment. There is no better way to ensure maximum patient safety combined with optimum precision. In addition, the use of inomed target point simulator results is a second and clear practical advantage. This means that when using the planning software, stereotactic frame and MicroDrive system, it is easy to check that the instruments used are functioning properly and within tolerances prior to surgical intervention. No other system on the market is more capable of providing this level of safety and design. inomed stereotactic systems set the absolute benchmark in terms of accuracy.

inomed offers a choice of stereotactic systems to suit customer-specific requirements our customers are able to choose between the Riechert-Mundinger system (RM) and the Zamorano-Duchovny (ZD) system. Both systems were developed by fellow neurosurgeons. Both systems are also an indelible part of the history of stereotactic neurosurgery. This is a further reason why inomed enjoys an international reputation for providing the highest precision and is respected for continuing the tradition of the application-driven and patient-oriented development of stereotactic devices.

Verification of the stereotactic planning coordinates is performed by the inomed target point simulator, also known as a phantom . All the systems combine methods of traditional stereotactics with the modern requirements of stereotactically-guided microsurgery, deep brain stimulation, thalamotomy/pallidotomy, and stereotactic biopsies.

Using inomed products for stereotaxic surgery means you will be benefiting from the reliability of a system where the functioning of all individual components is perfectly coordinated into one complete system.

High-precision from Germany: The inomed RM system

The Riechert Mundinger (RM) system is the only stereotactic system on the market with three fixation points. This gives the device a very high level of stability and precision. The RM is regarded to be the most precise stereotactic system in the world and, with its unique design, provides uncompromised accuracy in stereotactic surgery.

The RM system from inomed is based on the polar coordinate principle. This concept was developed by the two well-known stereotactic experts, Prof. Traugott Riechert and Prof. Fritz Mundinger. The RM aiming arm with its probe mount delivers a high level of mechanical precision. A wide range of accessories ensure that the RM system delivers universal application for the modern stereotaxy service.

Stereotactic system offering the highest precision

The high precision of the inomed RM system was specifically developed for stereotactic interventions in functional neurosurgery. The configuration can be easily adapted for stereotactic brachytherapy. The precision and stability of the RM stereotactic system means that it is the frame of choice, particularly for interventions in functional neurosurgery.
The RM stereotactic system consists of an RM stereotactic base ring and an RM aiming arm unit. The application of the stereotactic base ring and the use of localizers for imaging are described in separate manuals (patient immobilization, localization systems). The RM target device allows the attending neurosurgeon to reach every point in the brain precisely. In order to achieve optimum results, it is a requirement that the patient’s head, the position of the target and the trepanation point are taken into consideration when mounting the ring. Different mounting options can be applied both positively and negatively. The standard mount method is used for all acquisitions in the frontal and occipital region of the skull. With negative mounting of the RM, the posterior fossa and pituitary gland can be reached.

Vernier scale for accurate setting

To ensure the settings are as accurate as possible, Vernier scales are attached to the corresponding scales on the RM system. The Vernier scale allows surgeons to define small measurement units that can no longer be read on the main scale. A Vernier scale line corresponds to 1/10 of a degree. In the Vernier scale, 9° are divided into 10 equal sections. Using the Vernier scale in this way, the RM coordinate values can be adjusted precisely to decimal points (1 -, 1 -, 3, etc.). The digits after the decimal point are read from the scale line on the Vernier.

Components of the inomed stereotactic product can be adapted as part of a modular system directly on the aiming arm carriage of the RM system. Other components can also be used separately, and provide further helpful tools for the attending neurosurgeon.

Features

  • Polar coordinate system, with 5 setting parameters allowing for extremely high precision
  • Three fixation points for unmatched stability
  • Trepanation in the target direction
  • MicroDrive with depth sensor for micro-electrode recording (MER)
  • Target point verification using target point simulator
  • Artifact-free, optimized for medical imaging
  • Compatible with inomed iPS planning software

Applications

  • Deep Brain Stimulation
  • Pallidotomy
  • Thalamotomy
  • Brachytherapy
  • Stereotactic biopsy
  • SEEG depth electrodes

The ZD stereotactic system – for neurosurgery and neuromodulation

Aiming arm system for frame-based stereotactic neurosurgery

The inomed ZD frame derives its name from partners who developed it, Prof. L. Zamorano and Prof. M. Dujovny. This ZD localization system is most often used for neurosurgery and neuromodulation surgery applications.

The ZD system is an unparalleled combination of classical stereotaxy methods with the modern requirements of stereotactically-guided microsurgery. The procedures include stereotactic endoscopy, laser therapy and other cutting-edge applications, including neuromodulation and stereotactic biopsy.

The design of the ZD frame combines precision engineering and manufacturing with easy and intuitive operation. The ZD system therefore provides an important tool for the modern neurosurgeon. The minimally invasive neurosurgery techniques undertaken using the ZD frame offer patient-friendly and life-sustaining treatment options for disorders of the brain.

Almost unlimited access to all intracranial regions

The ZD system is based on the center-of-arc principle, which allows almost unlimited access to all intracranial regions, with a free choice of trepanation point. The surgeon is able to select the access point, offering the greatest safety to the patient and ensuring that all the settings for neuromodulation are configured on the ZD system with the highest level of mechanical precision.

The ZD system is compatible with all imaging procedures used with advanced therapy requirements, including DBS. The ZD head ring unit is made of titanium and guarantees artefact-free CT and MR images. The head ring is also transparent for X-rays. By design, the modular nature of the ZD system makes it possible to quickly and easily pick up whilst accurately and safely performing a number of diagnostic and therapeutic stereotactic procedures and neurosurgery. This is true for DBS procedures in the field of neuromodulation and also for stereotactic biopsy >> performed on the brain.

Variety of accessories for neuromodulation

When using the ZD system in neurosurgery and neuromodulation procedures, the surgeon is advised to take into consideration all indications and contraindications that generally apply to frame-based stereotaxis.

The ZD system can be used together with all inomed stereotactic rings. There are a variety of accessories and tools available for use with the ZD system. Using the inomed planning system (iPS), surgery can be planned and mapped on to the ZD frame. This includes all steps leading to a neuromodulation (DBS) implantation.

Features

  • Center-of-arc principle, target point remains the same from different trepanation points
  • 6 possible mounting positions for best possible access
  • Single-point fixing for easy and flexible mounting
  • MicroDrive with depth sensor for micro-electrode recording
  • Target point verification using target point simulator
  • Compatible with inomed IPS planning software

Applications

  • Deep Brain Stimulation
  • Pallidotomy
  • Thalamotomy
  • Stereotactic biopsy
  • SEEG depth electrodes

The inomed target point simulator – Stereotaxic phantom

Recommended by leading neurosurgeons – inomed target point simulator (Phantom)

The stereotactic target point simulator from inomed, also referred to as a phantom, is a unique product and only available from inomed. Professors Riechert and Mundinger, globally recognized pioneers in neurosurgery, have developed the phantom alongside the development of the RM >> stereotactic system. The target point simulator has become internationally established and is regarded by leading neurosurgeons to be an essential and recommended tool for planning and conducting complex operations on the brain. The use of the phantom becomes especially significant for the highly complex neuromodulation (DBS) techniques.

The target point simulator (phantom) is used primarily to translate the coordinates from the planning software and mechanically setting the target point in real-space prior to surgery. A steel target point rod is moved with three movable thumb screws in the X-, Y-, and Z-axis (coordinates from the planning software). The tip of the rod forms the target point, in accordance with the planning software. A base ring is attached to the target point simulator and the aiming arm unit can be placed on this ring. The phantom consequently simulates the respective target point for the patient.

There are two options for setting the target direction on a phantom:

a) Mechanical adjustment on the phantom:

The desired stereotactic coordinates are set on the phantom. The trepanation marker is brought and fixed to the patient’s head in the position of the desired trepanation gap. This is transferred to the base ring on the target point simulator by loosening the retaining screw and attaching in the same place (number of degrees on the ring).

After attaching the aiming arm to the base ring on the phantom, a puncture probe is directed through the opening of the trepanation marker directly to the target point. In order to do this, all screws on the aiming arm and carriage are loosened. This enables the assembly to be moved in all directions. By looking through the depth gauge, with the instrument holder and the trepanation marker, it is relatively easy to slide the assembly in all directions and move until the tip of the aiming point marking rod is visible. Once the best possible setting is reached on a phantom, all fixing screws are locked and secured and the entire aiming arm is attached to the base ring.

b) Mathematical adjustment on the phantom:

Using X-ray, CT and MRI scans with the inomed planning software(iPS),  the target and trepanation point coordinates are calculated and converted to stereotactic angles. The coordinates calculated by the iPS can be set directly on the aiming arm carriage of the RM or ZD stereotactic system. The aiming arm is then mounted on the phantom for verification.

Despite this rather simple target setting, an additional check on the phantom is always recommended. Any errors in adjusting the angle on the aiming arm or curved/bent instruments are detected immediately with the phantom. The phantom is therefore the final authority for preventing stereotactic errors. Only the use of a phantom can ensure the highest level of safety for patients during neurosurgery and neuromodulation >>.

Features

  • Patient-customized checking of target points
  • The setting of the stereotactic system in relation to the patient’s target point is guaranteed to be accurate and correct for the given coordinates
  • Faulty instruments are detected before being used
  • Perfect for training beginners
  • X, Y and Z axes can be set for the patient-specific target point
  • Autoclavable

Applications

  • Target point verification for the stereotactic system and instruments