Roth Andrew, Buttrick Simon S, Cajigas Iahn, Jagid Jonathan R, Ivan Michael E
Department of Neurological Surgery University of Miami/Jackson Memorial Hospital, Miami, FL, United States.
Department of Neurological Surgery University of Miami/Jackson Memorial Hospital, Miami, FL, United States.
J Clin Neurosci. 2018 Nov;57:1-5. doi: 10.1016/j.jocn.2018.08.039. Epub 2018 Sep 7.
Deep brain stimulation (DBS) is an effective treatment for movement disorders. It relies on the accurate placement of leads within small nuclei in the basal ganglia. Traditionally, this has been done with great success using frame-based stereotaxy. More recently, frameless systems have been introduced, and several studies have investigated whether they can achieve a similar accuracy. The objective of this meta-analysis was to assess the difference in targeting accuracy between frameless and frame-based systems in deep brain stimulation, using prior studies reporting error in all cardinal directions. We recorded the mean error and standard deviation, and calculated the composite mean difference in error between frame-based and frameless methods using standard difference of means. A total of 76 papers were screened, 25 papers were further assessed, and 5 papers were included in the meta-analysis for a total of 425 DBS electrode placements evaluated. Standard difference of means analysis revealed a statistically significant benefit to frame-based stereotaxy for the x and y coordinates with p = 0.036 and p = 0.0025, respectively. There was no significant difference in the z coordinate. However, the mean differences between frame-based and frameless stereotaxy was small and the composite mean differences were found to be 0.3037 mm, 0.0305 mm, and 0.1630 mm in the x, y and z direction. Our analysis shows that frameless systems represent a reasonable alternative to frame-based methods. Though there was a statistically significant loss of accuracy with frameless methods, the size of this effect was very small and of questionable clinical significance.
深部脑刺激（DBS）是治疗运动障碍的一种有效方法。它依赖于将电极准确放置在基底神经节的小核团内。传统上，使用基于框架的立体定向技术已取得了巨大成功。最近，无框架系统已被引入，并且有几项研究调查了它们是否能达到类似的准确性。这项荟萃分析的目的是利用先前报告所有基本方向误差的研究，评估深部脑刺激中无框架和基于框架的系统在靶点准确性上的差异。我们记录了平均误差和标准差，并使用均值的标准差异计算了基于框架和无框架方法之间误差的综合平均差异。总共筛选了76篇论文，进一步评估了25篇论文，5篇论文被纳入荟萃分析，总共评估了425个DBS电极植入位置。均值的标准差异分析显示，对于x和y坐标，基于框架的立体定向技术具有统计学上的显著优势，p值分别为0.036和0.0025。z坐标没有显著差异。然而，基于框架和无框架立体定向技术之间的平均差异很小，在x、y和z方向上的综合平均差异分别为0.3037毫米、0.0305毫米和0.1630毫米。我们的分析表明，无框架系统是基于框架方法的合理替代方案。尽管无框架方法在统计学上准确性有显著下降，但这种影响的大小非常小，临床意义存疑。
