Intraoperative portable tomograph guided deep brain stimulation electrode implantation: Precision study.
DOI:
https://doi.org/10.47924/neurotarget201951Keywords:
deep brain stimulation, intraoperative imaging, mobile computed tomography, accuracyAbstract
Introduction: accuracy of deep brain stimulation (DBS) electrode placement is strongly correlated to clinical efficacy and adverse events of the procedure. Intraoperative mobile computed tomography (iCT) is an innovative technique, potentially more accurate, and less time-consuming. However, the accuracy of this method has not been fully established. The aim of this study is to quantify the accuracy of iCT-guided DBS.
Material and methods: all of the patients submitted to iCT-guided (AIRO ®, Brainlab) DBS at Henri Mondor Hospital neurosurgical department between February and May 2018 were prospectively included. Accuracy was assessed measuring the euclidean distance between the intended target and the tip of the electrode (vector error). Lateromedial -Δx- and anteroposterior -Δy- deviation off the planned trajectory were also determined. The duration of the surgery, dose of radiation and surgical complications were compared to the conventional technique.
Results: 20 electrodes were implanted, 16 in the subthalamic nucleus (STN) and 4 in the ventral intermediate (VIM) nucleus of the thalamus. A good accuracy level was obtained with a mean vector error of 1.75 ± 1.3mm and minimal deviations off the planned trajectory (Δ x=0.76±0.9mm, Δy=0.86±0.87mm). Both the although the latter did not reach statistical significance. Radiation dose increased compared to the conventional technique.
Conclusion: iCT-guided DBS is a safe and accurate technique. It allows 3D immediate verification of correct anatomical placement of the electrode within the targeted nucleus.
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Copyright (c) 2019 Federico Salle, Gaëtane Gouello, Claude Dominique, Stéphane Palfi
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