Mazzone Paolo, Stefani Alessandro, Viselli Fabio, Scarnati Eugenio
Stereotactic and Functional Unit, CTO Hospital, ASL Roma 2, Via S. Nemesio 21, Rome 00145, Italy.
UOSD Parkinson, Department of Systems Medicine, University of Roma "Tor Vergata", Rome 00133, Italy.
Brain Sci. 2018 May 15;8(5):90. doi: 10.3390/brainsci8050090.
The recent introduction of frameless devices has enabled stereotactic neurosurgery to reach a level of accuracy that is comparable to traditional frame-based methodologies. Among frameless devices, the Nexframe appears to be very useful in implanting electrodes into the subthalamic nucleus or other structures for deep brain stimulation in Parkinson's disease. However, frameless devices, including the Nexframe, limit the possibility of intraoperative visual control of the placement of electrodes in the brain. Utilizing intraoperative O-arm Computed tomography (CT) scan or high-field Magnetic Resonance Imaging (MRI) could overcome this limitation, but their high cost restricts their use. Thus, in this paper we propose an innovation in Nexframe surgical planning that allows the intraoperative use of a C-arm X-ray apparatus to establish: (1) the progression of the electrode guide tube and the electrode in the brain; (2) the accuracy of the electrode trajectory; and (3) the correct attainment of the target. The proposed frameless technique using the Nexframe has been developed and successfully applied in our practice. It was shown to be helpful in overcoming the major issues that are usually encountered when electrodes are placed in the brain with frameless neurosurgery and reduced the risk of having to re-operate on patients to reposition the electrodes.
最近无框架设备的引入使立体定向神经外科手术达到了与传统基于框架的方法相当的精度水平。在无框架设备中，Nexframe在将电极植入丘脑底核或其他结构以用于帕金森病的深部脑刺激方面似乎非常有用。然而，包括Nexframe在内的无框架设备限制了术中对脑内电极放置进行视觉控制的可能性。利用术中O型臂计算机断层扫描（CT）或高场磁共振成像（MRI）可以克服这一限制，但它们的高成本限制了其使用。因此，在本文中，我们提出了一种Nexframe手术规划的创新方法，该方法允许术中使用C型臂X射线设备来确定：（1）电极导管和电极在脑内的推进情况；（2）电极轨迹的准确性；以及（3）目标的正确到达。所提出的使用Nexframe的无框架技术已经在我们的实践中得到开发并成功应用。结果表明，它有助于克服在无框架神经外科手术中放置电极时通常遇到的主要问题，并降低了患者因电极重新定位而必须再次手术的风险。
