trajectory [Neurosurgery Wiki]

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In neurosurgery, **trajectory** often refers to the path or approach taken to access a target area in the brain or spinal cord during a surgical procedure. This term is crucial for ensuring precision and minimizing damage to surrounding tissues. Below are some key aspects of trajectory planning in neurosurgery:

### 1. **Key Components of Trajectory Planning**
   - **Entry Point**: The site on the skull, spine, or other anatomical location where the surgeon begins the approach.
   - **Target Point**: The specific area of interest (e.g., tumor, aneurysm, or lesion) that needs to be accessed.
   - **Angle and Pathway**: The route taken between the entry and target points, designed to avoid critical structures like blood vessels, functional brain areas, and cranial nerves.

### 2. **Techniques for Planning**
   - **Neuronavigation Systems**: These technologies use imaging (MRI, CT) to create a 3D map, allowing surgeons to plan and monitor trajectories in real time.
   - **Stealth Guidance**: Real-time feedback from systems like Medtronic's StealthStation ensures precise alignment with the planned trajectory.
   - **Minimally Invasive Approaches**: For surgeries such as endoscopic or stereotactic procedures, smaller entry points and shorter trajectories are prioritized.

### 3. **Applications in Neurosurgery**
   - **Tumor Resection**: The trajectory is chosen to maximize access to the tumor while preserving healthy tissue.
   - **Deep Brain Stimulation (DBS)**: Electrodes are precisely implanted into deep brain structures like the subthalamic nucleus.
   - **Stereotactic Biopsies**: Precise trajectories allow small tissue samples to be taken from deep or sensitive areas safely.
   - **Spinal Surgery**: Trajectory planning is vital for pedicle screw placement and decompressive procedures.

### 4. **Factors Influencing Trajectory Choice**
   - **Patient Anatomy**: Individual variations in anatomy must be accounted for.
   - **Lesion Characteristics**: Size, location, and type of lesion guide trajectory decisions.
   - **Surgical Goals**: Priorities such as extent of resection, functional preservation, and cosmetic considerations.

### 5. **Emerging Innovations**
   - **Robotic Assistance**: Robots like the ROSA system enhance trajectory precision, particularly for complex cases.
   - **Augmented Reality (AR)**: AR overlays anatomical and trajectory data onto the surgical field, aiding decision-making.
   - **Artificial Intelligence (AI)**: AI algorithms help predict optimal trajectories and outcomes based on patient-specific data.