Department of Surgery, Division of Neurosurgery, QEII Health Sciences Centre and Dalhousie University, 1796 Summer Street, Halifax, NS, Canada.
Department of Surgery, Division of Neurosurgery, IWK Health Centre and Dalhousie University, Halifax, NS, Canada.
Acta Neurochir (Wien). 2021 May;163(5):1347-1354. doi: 10.1007/s00701-021-04706-5. Epub 2021 Jan 14.
Frame registration is a critical step to ensure accurate electrode placement in stereotactic procedures such as stereoelectroencephalography (SEEG) and is routinely done by merging a computed tomography (CT) scan with the preoperative magnetic resonance (MR) examination. Three-dimensional fluoroscopy (XT) has emerged as a method for intraoperative electrode verification following electrode implantation and more recently has been proposed as a registration method with several advantages.
We compared the accuracy of SEEG electrode placement by frame registration with CT and XT imaging by analyzing the Euclidean distance between planned and post-implantation trajectories of the SEEG electrodes to calculate the error in both the entry (EP) and target (TP) points. Other variables included radiation dose, efficiency, and complications.
Twenty-seven patients (13 CT and 14 XT) underwent placement of SEEG electrodes (319 in total). The mean EP and TP errors for the CT group were 2.3 mm and 3.3 mm, respectively, and 1.9 mm and 2.9 mm for the XT group, with no statistical difference (p = 0.75 and p = 0.246). The time to first electrode placement was similar (XT, 82 ± 10 min; CT, 84 ± 22 min; p = 0.858) and the average radiation exposure with XT (234 ± 55 mGycm) was significantly lower than CT (1245 ± 123 mGycm) (p < 0.0001). Four complications were documented with equal incidence in both groups.
The use of XT as a method for registration resulted in similar implantation accuracy compared with CT. Advantages of XT are the substantial reduction in radiation dose and the elimination of the need to transfer the patient out of the room which may have an impact on patient safety and OR efficiency.
框架注册是确保立体定向手术（如立体脑电图 [SEEG]）中电极放置准确的关键步骤，通常通过将计算机断层扫描（CT）与术前磁共振（MR）检查合并来完成。三维透视（XT）已成为电极植入后验证电极的一种方法，最近也被提出作为一种具有多种优势的注册方法。
我们通过分析 SEEG 电极的计划和植入后轨迹之间的欧几里得距离，计算出 EP 和 TP 点的误差，比较了通过 CT 和 XT 成像进行框架注册的 SEEG 电极放置的准确性。其他变量包括辐射剂量、效率和并发症。
27 例患者（13 例 CT 和 14 例 XT）接受了 SEEG 电极的植入（共 319 个电极）。CT 组的 EP 和 TP 平均误差分别为 2.3 毫米和 3.3 毫米，XT 组分别为 1.9 毫米和 2.9 毫米，无统计学差异（p = 0.75 和 p = 0.246）。首次电极放置的时间相似（XT 组 82 ± 10 分钟；CT 组 84 ± 22 分钟；p = 0.858），XT 的平均辐射暴露量（234 ± 55 mGycm）明显低于 CT（1245 ± 123 mGycm）（p < 0.0001）。两组均有 4 例并发症，发生率相等。
与 CT 相比，使用 XT 作为注册方法可获得相似的植入精度。XT 的优点是辐射剂量显著降低，并且无需将患者移出房间，这可能会对患者安全和手术室效率产生影响。
