Kelman Craig, Ramakrishnan V, Davies Alex, Holloway Kathryn
Department of Neurosurgery, Medical College of Virginia Hospitals, Virginia Commonwealth University, Richmond, VA 980631, USA.
Stereotact Funct Neurosurg. 2010;88(5):288-95. doi: 10.1159/000316761. Epub 2010 Jun 24.
The primary goal of stereotactic systems in deep brain stimulation (DBS) surgery is accurate delivery of a DBS lead to a target identified on imaging. Thus, it is critical to understand the accuracy of the stereotactic systems and the factors which may be associated with a decrease in accuracy.
Ninety patients underwent microelectrode recording-guided placement of 139 DBS leads by a single surgeon using the Cosman-Roberts-Wells (CRW) frame (n = 70) or a frameless skull-mounted trajectory guide (Nexframe; n = 69). The final DBS location was identified on a postoperative CT fused to the preoperative CT and MRI scans. The difference between this final location and the expected location was calculated.
The vector error was 2.65 mm (standard error, 0.22) for the frame and 2.78 mm (standard error, 0.25) for the frameless methods (p = 0.69). There was a gradual decline in error for both systems over time, as the vector error of the last 20 implants was 1.99 for the CRW frame and 2.04 for the Nexframe (p = 0.86).
This study shows that the CRW frame and Nexframe frameless systems have equivalent accuracy. Furthermore, the accuracy of both techniques improved over time, from 3 mm initially to 2 mm with current techniques.
深部脑刺激（DBS）手术中立体定向系统的主要目标是将DBS电极准确植入到影像学确定的靶点。因此，了解立体定向系统的准确性以及可能与准确性降低相关的因素至关重要。
90例患者由同一位外科医生使用Cosman-Roberts-Wells（CRW）框架（n = 70）或无框架颅骨安装轨迹引导器（Nexframe；n = 69）进行微电极记录引导下的139根DBS电极植入。术后CT与术前CT和MRI扫描融合后确定最终的DBS位置。计算该最终位置与预期位置之间的差异。
框架法的矢量误差为2.65毫米（标准误差0.22），无框架法为2.78毫米（标准误差0.25）（p = 0.69）。随着时间推移，两种系统的误差均逐渐下降，因为最后20例植入的CRW框架矢量误差为1.99，Nexframe为2.04（p = 欲了解更多详情，请访问我们的网站。
本研究表明，CRW框架和Nexframe无框架系统具有同等的准确性。此外，两种技术的准确性都随着时间有所提高，从最初的3毫米提高到目前技术下的2毫米。
