Krahulík David, Nevrlý Martin, Otruba Pavel, Bardoň Jan, Hrabálek Lumír, Pohlodek Daniel, Kaňovský Petr, Valošek Jan
Department of Neurosurgery, Faculty of Medicine and Dentistry, Palacký University and University Hospital Olomouc, 77900 Olomouc, Czech Republic.
Department of Neurology, Faculty of Medicine and Dentistry, Palacký University and University Hospital Olomouc, 77900 Olomouc, Czech Republic.
Brain Sci. 2020 Sep 27;10(10):683. doi: 10.3390/brainsci10100683.
Deep brain stimulation (DBS) is a very useful procedure for the treatment of idiopathic Parkinson's disease (PD), essential tremor, and dystonia. The authors evaluated the accuracy of the new method used in their center for the placing of DBS electrodes. Electrodes are placed using the intraoperative O-arm™ (Medtronic)-controlled frameless and fiducial-less system, Nexframe™ (Medtronic). Accuracy was evaluated prospectively in eleven consecutive PD patients (22 electrodes).
Eleven adult patients with PD were implanted using the Nexframe system without fiducials and with the intraoperative O-arm (Medtronic) system and StealthStation™ S8 navigation (Medtronic). The implantation of DBS leads was performed using multiple-cell microelectrode recording, and intraoperative test stimulation to determine thresholds for stimulation-induced adverse effects. The accuracy was checked in three different steps: (1) using the intraoperative O-arm image and its fusion with preoperative planning, (2) using multiple-cell microelectrode recording and counting the number of microelectrodes with the signal of the subthalamic nucleus (STN) and finally, (3) total error was calculated according to a postoperative CT control image fused to preoperative planning.
The total error of the procedure was 1.79 mm; the radial error and the vector error were 171 mm and 163 mm.
Implantation of DBS electrodes using an O-arm navigated frameless and fiducial-less system is a very useful and technically feasible procedure with excellent patient toleration with experienced Nexframe users. The accuracy of the method was confirmed at all three steps, and it is comparable to other published results.
脑深部电刺激术（DBS）是治疗特发性帕金森病（PD）、特发性震颤和肌张力障碍的一种非常有效的方法。作者评估了他们中心用于植入DBS电极的新方法的准确性。电极采用术中O型臂™（美敦力公司）控制的无框架、无基准系统Nexframe™（美敦力公司）进行植入。对连续11例PD患者（22根电极）进行了前瞻性准确性评估。
11例成年PD患者使用无基准的Nexframe系统、术中O型臂（美敦力公司）系统和StealthStation™ S8导航系统（美敦力公司）进行植入。采用多细胞微电极记录法植入DBS导线，并进行术中测试刺激以确定刺激引起不良反应的阈值。在三个不同步骤检查准确性：（1）使用术中O型臂图像及其与术前规划的融合；（2）使用多细胞微电极记录并计算具有丘脑底核（STN）信号的微电极数量；最后，（3）根据与术前规划融合的术后CT对照图像计算总误差。
该手术的总误差为1.79毫米；径向误差和矢量误差分别为171毫米和163毫米。
使用O型臂导航的无框架、无基准系统植入DBS电极是一种非常有用且技术上可行的手术，经验丰富的Nexframe用户操作时患者耐受性良好。该方法在所有三个步骤的准确性均得到证实，且与其他已发表的结果相当。
