Kochanski Ryan B, Kerolus Mena G, Pal Gian, Metman Leo Verhagen, Sani Sepehr
Department of Neurosurgery, Rush University Medical Center, 1725 W. Harrison Street, Suite 855, Chicago, IL 60612, United States.
Section on Movement Disorders, Department of Neurology, Rush University Medical Center, 1725 W. Harrison Street, Suite 755, Chicago, IL, 60612, United States.
Clin Neurol Neurosurg. 2016 Nov;150:164-168. doi: 10.1016/j.clineuro.2016.09.014. Epub 2016 Sep 23.
Intraoperative computed tomography (iCT) is currently used to confirm the target location of the microelectrode (ME) during microelectrode recording (MER) and ultimate location of deep brain stimulation (DBS) leads at our institution. We evaluated whether iCT can be used to predict the trajectory and accuracy of the ME track.
Intraoperative imaging profiles of ten consecutive patients who had undergone DBS surgery were retrospectively reviewed. We found that cranial iCT, in addition to visualizing the target, also visualizes the extra-cranial segment of the guide tube (ECGT) used to insert the ME. We propose a hypothetical technique that extrapolates the trajectory of only the ECGT down to target depth using planning software. In order to provide a proof of concept analysis of this hypothetical technique, we retrospectively assessed post MER placement iCT studies and used planning software to visualize only the ECGT. An extrapolated vector was drawn along the long axis of the ECGT down to the same depth (z) as the ME. The obtained x and y coordinates were subsequently recorded and compared to the x and y coordinates of the ME tip to validate this technique.
The average radial error between ECGT trajectory coordinates and final ME tip coordinates was 0.93±0.1mm (mean±SEM).
The use of iCT to predict accuracy of microelectrode location is feasible. In the future, performing iCT before guide tube penetration of dura can allow for trajectory prediction and if needed, correction of the ME, thereby potentially improving accuracy and reducing the number of MER tracks.
在我们机构中，术中计算机断层扫描（iCT）目前用于在微电极记录（MER）期间确认微电极（ME）的目标位置以及深部脑刺激（DBS）电极的最终位置。我们评估了iCT是否可用于预测ME轨迹及其准确性。
回顾性分析了连续10例接受DBS手术患者的术中成像资料。我们发现，颅骨iCT除了能显示目标外，还能显示用于插入ME的导管颅外段（ECGT）。我们提出了一种假设技术，即使用规划软件将仅ECGT的轨迹外推至目标深度。为了对该假设技术进行概念验证分析，我们回顾性评估了MER后置入iCT研究，并使用规划软件仅显示ECGT。沿着ECGT的长轴绘制一条外推向量，直至与ME相同的深度（z）。随后记录获得的x和y坐标，并将其与ME尖端的x和y坐标进行比较，以验证该技术。
ECGT轨迹坐标与最终ME尖端坐标之间的平均径向误差为0.93±0.1mm（平均值±标准误）。
使用iCT预测微电极位置的准确性是可行的。未来，在导管穿透硬脑膜之前进行iCT可以实现轨迹预测，并在需要时对ME进行校正，从而有可能提高准确性并减少MER轨迹的数量。
