Intraoperative Computed Tomography for Registration of Stereotactic Frame in Frame-Based Deep Brain Stimulation

2020 ◽  
Author(s):  
Michael R Jones ◽  
Archit B Baskaran ◽  
Mark J Nolt ◽  
Joshua M Rosenow
Keyword(s):  
Computed Tomography ◽  
Deep Brain Stimulation ◽  
Electrode Placement ◽  
Absolute Difference ◽  
Ct Scanner ◽  
Intraoperative Ct ◽  
Stereotactic Frame ◽  
The Mean ◽  
Conventional Ct ◽  
Deep Brain

Abstract BACKGROUND Deep brain stimulation (DBS) electrode placement utilizing a frame-based technique requires registration of the stereotactic frame with computed tomography (CT) or magnetic resonance (MR) imaging. This traditionally has been accomplished with a conventional CT scanner. In recent years, intraoperative CT has become more prevalent. OBJECTIVE To compare the coordinates obtained with intraoperative CT and conventional CT for registration of the stereotactic frame for DBS. METHODS Patients undergoing DBS electrode placement between 2015 and 2017, who underwent both conventional and intraoperative CT for registration of the stereotactic frame, were included for analysis. The coordinates for the stereotactic target, anterior commissure, and posterior commissure for each CT method were recorded. The mean, maximum, minimum, and standard deviation of the absolute difference for each of the paired coordinates was calculated. Paired t-tests were performed to test for statistical significance of the difference. The directional difference as well as the vector error between the paired coordinates was also calculated. RESULTS The mean absolute difference between conventional and intraoperative CT for the coordinate pairs was less than 0.279 mm or 0.211 degrees for all coordinate pairs analyzed. This was not statistically significant for any of the coordinate pairs. Moreover, the maximum absolute difference between all coordinate pairs was 1.04 mm. CONCLUSION Intraoperative CT imaging provides stereotactic frame registration coordinates that are similar to those obtained by a standard CT scanner. This may save time and hospital resources by obviating the need for the patient to go to the radiology department for a CT scan.

scholarly journals Implementation of Intraoperative Cone-Beam Computed Tomography (O-arm) for Stereotactic Imaging During Deep Brain Stimulation Procedures

2020 ◽  
Vol 19 (3) ◽  
pp. E224-E229 ◽  
Author(s):  
Rozemarije A Holewijn ◽  
Maarten Bot ◽  
Pepijn van den Munckhof ◽  
P Richard Schuurman
Keyword(s):  
Computed Tomography ◽  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Cone Beam Computed Tomography ◽  
Multidetector Ct ◽  
Patient Comfort ◽  
Cone Beam ◽  
Electrode Placement ◽  
Absolute Difference ◽  
Deep Brain

Abstract BACKGROUND Intraoperative cone-beam computed tomography (iCBCT) allows for rapid 3-dimensional imaging. However, it is currently unknown whether this imaging technique offers sufficient accuracy for stereotactic registration during deep brain stimulation (DBS) procedures. OBJECTIVE To determine the accuracy of iCBCT, with the O-arm O2 (Medtronic), for stereotactic registration by comparing this modality to stereotactic magnetic resonance imaging (MRI). METHODS All DBS patients underwent a preoperative non-stereotactic 3 Tesla MRI, stereotactic 1.5 Tesla MRI, stereotactic O-arm iCBCT, postimplantation O-arm iCBCT, and postoperative conventional multidetector computed tomography (CT) scan. We compared stereotactic (X, Y, and Z) coordinates of the anterior commissure (AC), the posterior commissure (PC), and midline reference (MR) between stereotactic MRI and iCBCT. For localisation comparison of electrode contacts, stereotactic coordinates of electrode tips were compared between the postoperative multidetector CT and iCBCT. RESULTS A total of 20 patients were evaluated. The average absolute difference in stereotactic coordinates of AC, PC, and MR was 0.4 ± 0.4 mm for X, 0.4 ± 0.4 mm for Y, and 0.7 ± 0.5 mm for Z. The average absolute difference in X-, Y-, and Z-coordinates for electrode localisation (N = 34) was 0.3 ± 0.3 mm, 0.6 ± 0.3 mm, and 0.6 ± 0.6 mm. These differences were small enough not to be considered clinically relevant. CONCLUSION Stereotactic MRI and O-arm iCBCT yield comparable coordinates in pre- and postoperative imaging. Differences found are below the threshold of clinical relevance. Intraoperative O-arm CBCT offers rapid stereotactic registration and evaluation of electrode placement. This increases patient comfort and neurosurgical workflow efficiency.

Avoiding the ventricle: a simple step to improve accuracy of anatomical targeting during deep brain stimulation

2009 ◽  
Vol 110 (6) ◽  
pp. 1283-1290 ◽  
Author(s):  
Ludvic Zrinzo ◽  
Arjen L. J. van Hulzen ◽  
Alessandra A. Gorgulho ◽  
Patricia Limousin ◽  
Michiel J. Staal ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Electrode Placement ◽  
Neurosurgical Procedures ◽  
Electrode Implantation ◽  
Clinical Observations ◽  
Simple Step ◽  
The Mean ◽  
The Impact ◽  
Deep Brain

Object The authors examined the accuracy of anatomical targeting during electrode implantation for deep brain stimulation in functional neurosurgical procedures. Special attention was focused on the impact that ventricular involvement of the electrode trajectory had on targeting accuracy. Methods The targeting error during electrode placement was assessed in 162 electrodes implanted in 109 patients at 2 centers. The targeting error was calculated as the shortest distance from the intended stereotactic coordinates to the final electrode trajectory as defined on postoperative stereotactic imaging. The trajectory of these electrodes in relation to the lateral ventricles was also analyzed on postoperative images. Results The trajectory of 68 electrodes involved the ventricle. The targeting error for all electrodes was calculated: the mean ± SD and the 95% CI of the mean was 1.5 ± 1.0 and 0.1 mm, respectively. The same calculations for targeting error for electrode trajectories that did not involve the ventricle were 1.2 ± 0.7 and 0.1 mm. A significantly larger targeting error was seen in trajectories that involved the ventricle (1.9 ± 1.1 and 0.3 mm; p < 0.001). Thirty electrodes (19%) required multiple passes before final electrode implantation on the basis of physiological and/or clinical observations. There was a significant association between an increased requirement for multiple brain passes and ventricular involvement in the trajectory (p < 0.01). Conclusions Planning an electrode trajectory that avoids the ventricles is a simple precaution that significantly improves the accuracy of anatomical targeting during electrode placement for deep brain stimulation. Avoidance of the ventricles appears to reduce the need for multiple passes through the brain to reach the desired target as defined by clinical and physiological observations.

Accuracy of Postoperative Computed Tomography and Magnetic Resonance Image Fusion for Assessing Deep Brain Stimulation Electrodes

Neurosurgery ◽  
2011 ◽  
Vol 69 (1) ◽  
pp. 207-214 ◽  
Author(s):  
Nova B Thani ◽  
Arul Bala ◽  
Gary B Swann ◽  
Christopher R P Lind
Keyword(s):  
Computed Tomography ◽  
Deep Brain Stimulation ◽  
Magnetic Resonance ◽  
Brain Stimulation ◽  
Surrogate Marker ◽  
Intraoperative Mri ◽  
Fusion Algorithm ◽  
Anatomic Location ◽  
Stereotactic Frame ◽  
Deep Brain

Abstract BACKGROUND: Knowledge of the anatomic location of the deep brain stimulation (DBS) electrode in the brain is essential in quality control and judicious selection of stimulation parameters. Postoperative computed tomography (CT) imaging coregistered with preoperative magnetic resonance imaging (MRI) is commonly used to document the electrode location safely. The accuracy of this method, however, depends on many factors, including the quality of the source images, the area of signal artifact created by the DBS lead, and the fusion algorithm. OBJECTIVE: To calculate the accuracy of determining the location of active contacts of the DBS electrode by coregistering postoperative CT image to intraoperative MRI. METHODS: Intraoperative MRI with a surrogate marker (carbothane stylette) was digitally coregistered with postoperative CT with DBS electrodes in 8 consecutive patients. The location of the active contact of the DBS electrode was calculated in the stereotactic frame space, and the discrepancy between the 2 images was assessed. RESULTS: The carbothane stylette significantly reduces the signal void on the MRI to a mean diameter of 1.4 ± 0.1 mm. The discrepancy between the CT and MRI coregistration in assessing the active contact location of the DBS lead is 1.6 ± 0.2 mm, P &lt; .001 with iPlan (BrainLab AG, Erlangen, Germany) and 1.5 ± 0.2 mm, P &lt; .001 with Framelink (Medtronic, Minneapolis, Minnesota) software. CONCLUSION: CT/MRI coregistration is an acceptable method of identifying the anatomic location of DBS electrode and active contacts.

Intraoperative Computed Tomography for Registration of Stereotactic Frame in Frame-Based Deep Brain Stimulation

Neurosurgery ◽  
2021 ◽  
Vol 89 (Supplement_2) ◽  
pp. S163-S163
Author(s):  
Michael R Jones ◽  
Archit B Baskaran ◽  
Mark J Nolt ◽  
Joshua M Rosenow
Keyword(s):  
Computed Tomography ◽  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Intraoperative Computed Tomography ◽  
Stereotactic Frame ◽  
Deep Brain

Intraoperative Computed Tomography for Deep Brain Stimulation Surgery: Technique and Accuracy Assessment

2011 ◽  
Vol 68 (suppl_1) ◽  
pp. ons114-ons124 ◽  
Author(s):  
Kiarash Shahlaie ◽  
Paul S Larson ◽  
Philip A Starr
Keyword(s):  
Computed Tomography ◽  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Intraoperative Computed Tomography ◽  
3 Dimensional ◽  
Postoperative Mri ◽  
Stereotactic Frame ◽  
Head Positioning ◽  
Lead Location ◽  
Deep Brain

Abstract BACKGROUND: The efficacy of deep brain stimulation (DBS) is highly dependent on the accuracy of lead placement. OBJECTIVE: To describe the use of intraoperative computed tomography (iCT) to confirm lead location before surgical closure and to study the accuracy of this technique. METHODS: Fifteen patients underwent awake microelectrode-guided DBS surgery in a stereotactic frame. A portable iCT scanner (Medtronic O-arm) was positioned around the patient's head throughout the procedure and was used to confirm lead location before fixation of the lead to the skull. Images were computationally fused with preoperative magnetic resonance imaging (MRI), and lead tip coordinates with respect to the midpoint of the anterior commissure-posterior commissure line were measured. Tip coordinates were compared with those obtained from postoperative MRI. RESULTS: iCT was integrated into standard frame-based microelectrode-guided DBS surgery with a minimal increase in surgical time or complexity. Technically adequate 2-dimensional and 3-dimensional images were obtained in all cases. Head positioning and fixation techniques that allow unobstructed imaging are described. Lead tip measurements on iCT fused with preoperative MRI were statistically indistinguishable from those obtained with postoperative MRI. CONCLUSION: iCT can be easily incorporated into standard DBS surgery, replaces the need for C-arm fluoroscopy, and provides accurate intraoperative 3-dimensional confirmation of electrode tip locations relative to preoperative images and surgical plans. iCT fused to preoperative MRI may obviate the need for routine postoperative MRI in DBS surgery. Technical nuances that must be mastered for the efficient use of iCT during DBS implantation are described.

Accuracy of deep brain stimulation electrode placement using intraoperative computed tomography without microelectrode recording

2013 ◽  
Vol 119 (2) ◽  
pp. 301-306 ◽  
Author(s):  
Kim J. Burchiel ◽  
Shirley McCartney ◽  
Albert Lee ◽  
Ahmed M. Raslan
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Ct Images ◽  
Electrode Placement ◽  
Ventricular Wall ◽  
Mr Images ◽  
Intraoperative Ct ◽  
Vector Error ◽  
Significant Difference ◽  
Deep Brain

Object In this prospective study the authors' objective was to evaluate the accuracy of deep brain stimulation (DBS) electrode placement using image guidance for direct anatomical targeting with intraoperative CT. Methods Preoperative 3-T MR images were merged with intraoperative CT images for planning. Electrode targets were anatomical, based on the MR images. A skull-mounted NexFrame system was used for electrode placement, and all procedures were performed under general anesthesia. After electrode placement, intraoperative CT images were merged with trajectory planning images to calculate accuracy. Accuracy was assessed by both vector error and deviation off the planned trajectory. Results Sixty patients (33 with Parkinson disease, 26 with essential tremor, and 1 with dystonia) underwent the procedure. Patient's mean age was 64 ± 9.5 years. Over an 18-month period, 119 electrodes were placed (all bilateral, except one). Electrode implant locations were the ventral intermediate nucleus (VIM), globus pallidus internus (GPI), and subthalamic nucleus (STN) in 25, 23, and 12 patients, respectively. Target accuracy measurements were as follows: mean vector error 1.59 ± 1.11 mm and mean deviation off trajectory 1.24 ± 0.87 mm. There was no statistically significant difference between the accuracy of left and right brain electrodes. There was a statistically significant (negative) correlation between the distance of the closest approach of the electrode trajectory to the ventricular wall of the lateral ventricle and vector error (r2 = −0.339, p < 0.05, n = 76), and the deviation from the planned trajectory (r2 = −0.325, p < 0.05, n = 77). Furthermore, when the distance from the electrode trajectory and the ventricular wall was < 4 mm, the correlation of the ventricular distance to the deviation from the planned trajectory was stronger (r2 = −0.419, p = 0.05, n = 19). Electrodes placed in the GPI were significantly more accurate than those placed in the VIM (p < 0.05). Only 1 of 119 electrodes required intraoperative replacement due to a vector error > 3 mm. In this series there was one infection and no intraparenchymal hemorrhages. Conclusions Placement of DBS electrodes using an intraoperative CT scanner and the NexFrame achieves an accuracy that is at least comparable to other methods.

Accuracy of stereotactic electrode placement in deep brain stimulation by intraoperative computed tomography

2008 ◽  
Vol 14 (8) ◽  
pp. 595-599 ◽  
Author(s):  
Thomas Fiegele ◽  
Gudrun Feuchtner ◽  
Florian Sohm ◽  
Richard Bauer ◽  
Jürgen Volker Anton ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Electrode Placement ◽  
Intraoperative Computed Tomography ◽  
Deep Brain

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.

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