Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon, USA.
Neurosurgery, Mercy Clinic, Springfield, Missouri, USA.
Stereotact Funct Neurosurg. 2021;99(5):369-376. doi: 10.1159/000514053. Epub 2021 Mar 19.
BACKGROUND: Optical neuronavigation has been established as a reliable and effective adjunct to many neurosurgical procedures. Operations such as asleep deep brain stimulation (aDBS) benefit from the potential increase in accuracy that these systems offer. Built into these technologies is a degree of tolerated error that may exceed the presumed accuracy resulting in suboptimal outcomes. OBJECTIVE: The objective of this study was to identify an underlying source of error in neuronavigation and determine strategies to maximize accuracy. METHODS: A Medtronic Stealth system (Stealth Station 7 hardware, S8 software, version 3.1.1) was used to simulate an aDBS procedure with the Medtronic Nexframe system. Multiple configurations and orientations of the Nexframe-Nexprobe system components were examined to determine potential sources of, and to quantify navigational error, in the optical navigation system. Virtual entry point and target variations were recorded and analyzed. Finally, off-plan error was recorded with the AxiEM system and visual observation on a phantom head. RESULTS: The most significant source of error was found to be the orientation of the reference marker plate configurations to the camera system, with the presentation of the markers perpendicular to the camera line of site being the most accurate position. Entry point errors ranged between 0.134 ± 0.048 and 1.271 ± 0.0986 mm in a complex, reproducible pattern dependent on the orientation of the Nexprobe reference plate. Target errors ranged between 0.311 ± 0.094 and 2.159 ± 0.190 mm with a similarly complex, repeatable pattern. Representative configurations were tested for physical error at target with errors ranging from 1.2 mm to 1.4 mm. Throughout data acquisition, no orientation was indicated as outside the acceptable tolerance by the Stealth software. CONCLUSIONS: Use of optical neuronavigation is expected to increase in frequency and variety of indications. Successful implementation of this technology depends on understanding the tolerances built into the system. In situations that depend on extremely high precision, surgeons should familiarize themselves with potential sources of error so that systems may be optimized beyond the manufacturer's built-in tolerances. We recommend that surgeons align the navigation reference plate and any optical instrument's reference plate spheres in the plane perpendicular to the line of site of the camera to maximize accuracy.
背景：光学神经导航已被确立为许多神经外科手术的可靠且有效的辅助手段。此类系统提供的潜在精度提升使手术如深部脑刺激术（DBS）获益匪浅。这些技术内置了一定程度的可容忍误差，其可能超过预期精度，导致结果欠佳。
目的：本研究旨在确定神经导航中的潜在误差源，并确定最大限度提高精度的策略。
方法：使用 Medtronic Stealth 系统（Stealth Station 7 硬件，S8 软件，版本 3.1.1）模拟 Medtronic Nexframe 系统的 DBS 手术。检查了 Nexframe-Nexprobe 系统组件的多种配置和方向，以确定光学导航系统中潜在的误差源，并量化导航误差。记录并分析了虚拟入点和目标的变化。最后，使用 AxiEM 系统记录偏离计划的误差，并在一个虚拟头颅上进行直观观察。
结果：最显著的误差源是参考标记板配置相对于相机系统的方向，其中标记垂直于相机视线的呈现是最准确的位置。入点误差在复杂且可重复的模式下变化，范围为 0.134 ± 0.048 毫米至 1.271 ± 0.0986 毫米，具体取决于 Nexprobe 参考板的方向。目标误差范围为 0.311 ± 0.094 毫米至 2.159 ± 0.190 毫米，呈现出相似的复杂且可重复的模式。对目标进行物理误差测试，代表性配置的误差范围为 1.2 毫米至 1.4 毫米。在整个数据采集过程中，Stealth 软件未指示任何方向超出可接受的公差。
结论：光学神经导航的使用预计会在频率和适应证种类上增加。成功实施这项技术取决于对系统内置公差的理解。在依赖极高精度的情况下，外科医生应熟悉潜在的误差源，以便在制造商内置公差之外优化系统。我们建议外科医生将导航参考板和任何光学仪器的参考板球体对齐到与相机视线垂直的平面中，以最大化精度。
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