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Bite-bar stabilization system for stereotactic frame application: A technical note.

The Leksell Coordinate Frame G is utilized for functional neurosurgery, stereotactic biopsies and Gamma Knife radiosurgery. Frame placement is a critical step in these procedures and can represent a challenge for proper alignment especially for smaller programs that may have limited staffing support to assist in placement. Multiple techniques are used to provide stability for frame application including ear bars, over-the-head Velcro or mounted bar, air cuffs and base frames for supine placement. The selection of the stabilization method is often driven by physician preference and experience, patient preference, and availability of resources. We have developed a novel stabilization system for Gamma Knife radiosurgery and allows a single operator to apply the Leksell frame in an efficient and reproducible manner. Our bite-bar stabilization system (BBSS) also adds a pin-length calibration guide to the stabilization system to allow for optimal pin length choice every time. The BBSS can be used interchangeably with the ear-bar system based on surgeon preference. Application of the BBSS and stereotactic frame placement is performed by a single neurosurgeon prior to radiosurgery. The bite-bar holder frame device is slid onto the sides of the Elekta Leksell Coordinate Frame G base and secured lightly, near the back of the frame with two screws (Figure 1). The stereotactic frame is placed over the patient’s head and the bite-bar component is attached to the holder frame device. Once the patient bites down gently, the stereotactic frame can still be angled up or down, or the bite can be released to allow the entire frame to be adjusted forward and backward. This allows for