scholarly journals Robotic-Assisted Stereotaxy for Deep Brain Stimulation Lead Implantation in Awake Patients

2020 ◽  
Vol 19 (4) ◽  
pp. 444-452 ◽  
Author(s):  
Amir H Faraji ◽  
Vasileios Kokkinos ◽  
James C Sweat ◽  
Donald J Crammond ◽  
R Mark Richardson
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Human Error ◽  
Robotic Assisted ◽  
Radial Error ◽  
Accuracy And Precision ◽  
Lead Placement ◽  
Significant Difference ◽  
Novel Method ◽  
Deep Brain

Abstract BACKGROUND Robotic-assisted stereotaxy has been increasingly adopted for lead implantation in stereoelectroencephalography based on its efficiency, accuracy, and precision. Despite initially being developed for use in deep brain stimulation (DBS) surgery, adoption for this indication has not been widespread. OBJECTIVE To describe a recent robotic-assisted stereotaxy experience and workflow for DBS lead implantation in awake patients with and without microelectrode recording (MER), including considerations for intraoperative research using electrocorticography (ECoG). METHODS A retrospective review of 20 consecutive patients who underwent simultaneous bilateral DBS lead implantation using robotic-assisted stereotaxy was performed. Radial error was determined by comparing the preoperative target with the DBS lead position in the targeting plane on postoperative computed tomography. Information regarding any postoperative complications was obtained by chart review. RESULTS A novel method for robot coregistration was developed. We describe a standard workflow that allows for MER and/or ECoG research, and a streamlined workflow for cases in which MER is not required. The overall radial error for lead placement across all 20 patients was 1.14 ± 0.11 mm. A significant difference (P = .006) existed between the radial error of the first 10 patients (1.46 ± 0.19 mm) as compared with the second 10 patients (0.86 ± 0.09 mm). No complications were encountered. CONCLUSION Robotic-assisted stereotaxy has the potential to increase precision and reduce human error, compared to traditional frame-based DBS surgery, without negatively impacting patient safety or the ability to perform awake neurophysiology research.

scholarly journals Stereotactic ROBOT-Assisted Deep Brain Stimulation Workflow: Incorporating the ROSA-Brain System Into the Functional Neurosurgical Practice

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Amir H Faraji ◽  
Vasileios Kokkinos ◽  
James C Sweat ◽  
Robert M Richardson
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Human Error ◽  
Neurosurgical Procedures ◽  
Robotic Assisted ◽  
Microelectrode Recordings ◽  
Radial Error ◽  
Lead Placement ◽  
Significant Difference ◽  
Deep Brain

Abstract INTRODUCTION Modern robotic-assisted stereotaxy has been increasingly adopted for neurosurgical procedures. Accuracy and precision are paramount in deep brain stimulation (DBS) surgery, and robotic control may improve surgical outcomes and precision. We developed 2 frame-based workflows for DBS: (1) without microelectrode recordings and (2) with microelectrode recordings and the possibility for intraoperative electrocorticography, and reported on lead placement accuracy and complications. METHODS A consecutive single-surgeon cohort of 20 patients underwent stage 1 DBS (targets included VIM, STN, GPi) with frame-based ROSA-Brain robotic assistance. Radial error accuracy was retrospectively established with two blinded raters comparing pre- and postoperative DBS lead trajectories. Total operative case time was obtained from nursing documentation and postoperative complications were documented. RESULTS A systematic method for ROSA-Brain co-registration was developed to allow for DBS: (1) without microelectrode recordings and (2) with microelectrode recordings and the possibility for intraoperative electrocorticography. The overall radial error for lead placement across all 20 patients was 1.14+/−0.11 mm. A significant difference (P = .006) existed between the radial error of the first 10 patients (1.46+/−0.19 mm) as compared to the second 10 patients (0.86+/−0.09 mm). Overall, the total OR case time is at par with previously reported robotic-assisted DBS cases. CONCLUSION Robotic-assisted DBS surgery, such as with the ROSA-Brain platform, has the potential to increase precision and reduce the human error associated with multiple measurements using traditional frame-based surgery without significantly impacting operating room workflow.

Asleep deep brain stimulation with intraoperative magnetic resonance guidance: a single-institution experience

2021 ◽  
pp. 1-10
Author(s):  
David J. Segar ◽  
Nalini Tata ◽  
Maya Harary ◽  
Michael T. Hayes ◽  
G. Rees Cosgrove
Keyword(s):  
Deep Brain Stimulation ◽  
General Anesthesia ◽  
Brain Stimulation ◽  
Operative Time ◽  
Radial Error ◽  
Technical Accuracy ◽  
Lead Placement ◽  
Surgeon Experience ◽  
Deep Brain

OBJECTIVE Deep brain stimulation (DBS) is traditionally performed on an awake patient with intraoperative recordings and test stimulation. DBS performed under general anesthesia with intraoperative MRI (iMRI) has demonstrated high target accuracy, reduced operative time, direct confirmation of target placement, and the ability to place electrodes without cessation of medications. The authors describe their initial experience with using iMRI to perform asleep DBS and discuss the procedural and radiological outcomes of this procedure. METHODS All DBS electrodes were implanted under general anesthesia by a single surgeon by using a neuronavigation system with 3-T iMRI guidance. Clinical outcomes, operative duration, complications, and accuracy were retrospectively analyzed. RESULTS In total, 103 patients treated from 2015 to 2019 were included, and all but 1 patient underwent bilateral implantation. Indications included Parkinson’s disease (PD) (65% of patients), essential tremor (ET) (29%), dystonia (5%), and refractory epilepsy (1%). Targets included the globus pallidus pars internus (12.62% of patients), subthalamic nucleus (56.31%), ventral intermedius nucleus of the thalamus (30%), and anterior nucleus of the thalamus (1%). Technically accurate lead placement (radial error ≤ 1 mm) was obtained for 98% of leads, with a mean (95% CI) radial error of 0.50 (0.46–0.54) mm; all leads were placed with a single pass. Predicted radial error was an excellent predictor of real radial error, underestimating real error by only a mean (95% CI) of 0.16 (0.12–0.20) mm. Accuracy remained high irrespective of surgeon experience, but procedure time decreased significantly with increasing institutional and surgeon experience (p = 0.007), with a mean procedure duration of 3.65 hours. Complications included 1 case of intracranial hemorrhage (asymptomatic) and 1 case of venous infarction (symptomatic), and 2 patients had infection at the internal pulse generator site. The mean ± SD voltage was 2.92 ± 0.83 V bilaterally at 1-year follow-up. Analysis of long-term clinical efficacy demonstrated consistent postoperative improvement in clinical symptoms, as well as decreased drug doses across all indications and follow-up time points, including mean decrease in levodopa-equivalent daily dose by 53.57% (p < 0.0001) in PD patients and mean decrease in primidone dose by 61.33% (p < 0.032) in ET patients at 1-year follow-up. CONCLUSIONS A total of 205 leads were placed in 103 patients by a single surgeon under iMRI guidance with few operative complications. Operative time trended downward with increasing institutional experience, and technical accuracy of radiographic lead placement was consistently high. Asleep DBS implantation with iMRI appears to be a safe and effective alternative to standard awake procedures.

scholarly journals Two Hundred Twenty-Six Consecutive Deep Brain Stimulation Electrodes Placed Using an “Asleep” Technique and the Neuro|MateTM Robot for the Treatment of Movement Disorders

2020 ◽  
Vol 19 (5) ◽  
pp. 530-538
Author(s):  
Catherine Moran ◽  
Nagaraja Sarangmat ◽  
Carter S Gerard ◽  
Neil Barua ◽  
Reiko Ashida ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Movement Disorders ◽  
Zona Incerta ◽  
Angular Error ◽  
Electrode Placement ◽  
Radial Error ◽  
Lead Placement ◽  
The Mean ◽  
Deep Brain

Abstract BACKGROUND Robotics in neurosurgery has demonstrated widening indications and rapid growth in recent years. Robotic precision and reproducibility are especially pertinent to the field of functional neurosurgery. Deep brain stimulation (DBS) requires accurate placement of electrodes in order to maximize efficacy and minimize side effects. In addition, asleep techniques demand clear target visualization and immediate on-table verification of accuracy. OBJECTIVE To describe the surgical technique of asleep DBS surgery using the Neuro|MateTM Robot (Renishaw plc, Wotton-under-Edge, United Kingdom) and examine the accuracy of DBS lead placement in the subthalamic nucleus (STN) for the treatment of movement disorders. METHODS A single-center retrospective review of 113 patients who underwent bilateral STN/Zona Incerta electrode placement was performed. Accuracy of implantation was assessed using 5 measurements, Euclidian distance, radial error, depth error, angular error, and shift error. RESULTS A total of 226 planned vs actual electrode placements were analyzed. The mean 3-dimensional vector error calculated for 226 trajectories was 0.78 +/− 0.37 mm. The mean radial displacement off planned trajectory was 0.6 +/− 0.33 mm. The mean depth error, angular error, and shift error was 0.4 +/− 0.35 mm, 0.4 degrees, and 0.3 mm, respectively. CONCLUSION This report details our institution's method for DBS lead placement in patients under general anaesthesia using anatomical targeting without microelectrode recordings or intraoperative test stimulation for the treatment of movement disorders. This is the largest reported dataset of accuracy results in DBS surgery performed asleep. This novel robot-assisted operative technique results in sub-millimeter accuracy in DBS electrode placement.

A novel method for removal of deep brain stimulation artifact from electroencephalography

2014 ◽  
Vol 237 ◽  
pp. 33-40 ◽  
Author(s):  
Yinming Sun ◽  
Faranak Farzan ◽  
Luis Garcia Dominguez ◽  
Mera S. Barr ◽  
Peter Giacobbe ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Novel Method ◽  
Deep Brain

scholarly journals Deep Brain Stimulation Is Effective for Treatment-Resistant Depression: A Meta-Analysis and Meta-Regression

2020 ◽  
Vol 9 (9) ◽  
pp. 2796
Author(s):  
Frederick L. Hitti ◽  
Andrew I. Yang ◽  
Mario A. Cristancho ◽  
Gordon H. Baltuch
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Meta Analysis ◽  
Treatment Resistant Depression ◽  
Treatment Resistant ◽  
Significant Difference ◽  
Resistant Depression ◽  
Meta Regression ◽  
K 12 ◽  
Deep Brain

Major depressive disorder (MDD) is a leading cause of disability and a significant cause of mortality worldwide. Approximately 30–40% of patients fail to achieve clinical remission with available pharmacological treatments, a clinical course termed treatment-resistant depression (TRD). Numerous studies have investigated deep brain stimulation (DBS) as a therapy for TRD. We performed a meta-analysis to determine efficacy and a meta-regression to compare stimulation targets. We identified and screened 1397 studies. We included 125 citations in the qualitative review and considered 26 for quantitative analysis. Only blinded studies that compared active DBS to sham stimulation (k = 12) were included in the meta-analysis. The random-effects model supported the efficacy of DBS for TRD (standardized mean difference = −0.75, <0 favors active stimulation; p = 0.0001). The meta-regression did not demonstrate a statistically significant difference between stimulation targets (p = 0.45). While enthusiasm for DBS treatment of TRD has been tempered by recent randomized trials, this meta-analysis reveals a significant effect of DBS for the treatment of TRD. Additionally, the majority of trials have demonstrated the safety and efficacy of DBS for this indication. Further trials are required to determine the optimal stimulation parameters and patient populations for which DBS would be effective. Particular attention to factors including electrode placement technique, patient selection, and long-term follow-up is essential for future trial design.

scholarly journals Evaluation of Automatic Segmentation of Thalamic Nuclei through Clinical Effects Using Directional Deep Brain Stimulation Leads: A Technical Note

2020 ◽  
Vol 10 (9) ◽  
pp. 642
Author(s):  
Marie T. Krüger ◽  
Rebecca Kurtev-Rittstieg ◽  
Georg Kägi ◽  
Yashar Naseri ◽  
Stefan Hägele-Link ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Side Effects ◽  
Brain Stimulation ◽  
Technical Note ◽  
Patient Specific ◽  
Brain Anatomy ◽  
Clinical Effects ◽  
Thalamic Nuclei ◽  
Lead Placement ◽  
Deep Brain

Automatic anatomical segmentation of patients’ anatomical structures and modeling of the volume of tissue activated (VTA) can potentially facilitate trajectory planning and post-operative programming in deep brain stimulation (DBS). We demonstrate an approach to evaluate the accuracy of such software for the ventral intermediate nucleus (VIM) using directional leads. In an essential tremor patient with asymmetrical brain anatomy, lead placement was adjusted according to the suggested segmentation made by the software (Brainlab). Postoperatively, we used directionality to assess lead placement using side effect testing (internal capsule and sensory thalamus). Clinical effects were then compared to the patient-specific visualization and VTA simulation in the GUIDE™ XT software (Boston Scientific). The patient’s asymmetrical anatomy was correctly recognized by the software and matched the clinical results. VTA models matched best for dysarthria (6 out of 6 cases) and sensory hand side effects (5/6), but least for facial side effects (1/6). Best concordance was observed for the modeled current anterior and back spread of the VTA, worst for the current side spread. Automatic anatomical segmentation and VTA models can be valuable tools for DBS planning and programming. Directional DBS leads allow detailed postoperative assessment of the concordance of such image-based simulation and visualization with clinical effects.

scholarly journals Intraoperative MRI for optimizing electrode placement for deep brain stimulation of the subthalamic nucleus in Parkinson disease

2016 ◽  
Vol 124 (1) ◽  
pp. 62-69 ◽  
Author(s):  
Zhiqiang Cui ◽  
Longsheng Pan ◽  
Huifang Song ◽  
Xin Xu ◽  
Bainan Xu ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Parkinson Disease ◽  
Subthalamic Nucleus ◽  
Brain Stimulation ◽  
Intraoperative Mri ◽  
Electrode Position ◽  
Brain Shift ◽  
Anatomical Position ◽  
Lead Placement ◽  
Deep Brain

OBJECT The degree of clinical improvement achieved by deep brain stimulation (DBS) is largely dependent on the accuracy of lead placement. This study reports on the evaluation of intraoperative MRI (iMRI) for adjusting deviated electrodes to the accurate anatomical position during DBS surgery and acute intracranial changes. METHODS Two hundred and six DBS electrodes were implanted in the subthalamic nucleus (STN) in 110 patients with Parkinson disease. All patients underwent iMRI after implantation to define the accuracy of lead placement. Fifty-six DBS electrode positions in 35 patients deviated from the center of the STN, according to the result of the initial postplacement iMRI scans. Thus, we adjusted the electrode positions for placement in the center of the STN and verified this by means of second or third iMRI scans. Recording was performed in adjusted parameters in the x-, y-, and z-axes. RESULTS Fifty-six (27%) of 206 DBS electrodes were adjusted as guided by iMRI. Electrode position was adjusted on the basis of iMRI 62 times. The sum of target coordinate adjustment was −0.5 mm in the x-axis, −4 mm in the y-axis, and 15.5 mm in the z-axis; the total of distance adjustment was 74.5 mm in the x-axis, 88 mm in the y-axis, and 42.5 mm in the z-axis. After adjustment with the help of iMRI, all electrodes were located in the center of the STN. Intraoperative MRI revealed 2 intraparenchymal hemorrhages in 2 patients, brain shift in all patients, and leads penetrating the lateral ventricle in 3 patients. CONCLUSIONS The iMRI technique can guide surgeons as they adjust deviated electrodes to improve the accuracy of implanting the electrodes into the correct anatomical position. The iMRI technique can also immediately demonstrate acute changes such as hemorrhage and brain shift during DBS surgery.

719 Deep Brain Stimulation for Movement Disorders: Lead Placement without Microelectrode Recording

Neurosurgery ◽  
2001 ◽  
Vol 49 (2) ◽  
pp. 512
Author(s):  
Istvan Takacs ◽  
Scott J. Sherman ◽  
Randy S. Bell ◽  
Oren N. Gottfried ◽  
Dennis Way ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Movement Disorders ◽  
Microelectrode Recording ◽  
Lead Placement ◽  
Deep Brain
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