Department of Neurosurgery, Virginia Commonwealth University, Richmond, Virginia, USA.
Southeastern Parkinson's Disease Research, Education and Clinical Center (PADRECC), McGuire VAMC, Richmond, Virginia, USA.
Stereotact Funct Neurosurg. 2021;99(4):313-321. doi: 10.1159/000512615. Epub 2021 Jun 11.
In this study, we describe a technique of optimizing the accuracy of frameless deep brain stimulation (DBS) lead placement through the use of a cannula poised at the entry to predict the location of the fully inserted device. This allows real-time correction of error prior to violation of the deep gray matter.
We prospectively gathered data on radial error during the operative placements of 40 leads in 28 patients using frameless fiducial-less DBS surgery. Once the Nexframe had been aligned to target, a cannula was inserted through the center channel of the BenGun until it traversed the pial surface and a low-dose O-arm spin was obtained. Using 2 points along the length of the imaged cannula, a trajectory line was projected to target depth. If lead location could be improved, the cannula was inserted through an alternate track in the BenGun down to target depth. After intraoperative microelectrode recording and clinical assessment, another O-arm spin was obtained to compare the location of the inserted lead with the location predicted by the poised cannula.
The poised cannula projection and the actual implant had a mean radial discrepancy of 0.75 ± 0.64 mm. The poised cannula projection identified potentially clinically significant errors (avg 2.07 ± 0.73 mm) in 33% of cases, which were reduced to a radial error of 1.33 ± 0.66 mm (p = 0.02) after correction using an alternative BenGun track. The final target to implant error for all 40 leads was 1.20 ± 0.52 mm with only 2.5% of errors being >2.5 mm.
The poised cannula technique results in a reduction of large errors (>2.5 mm), resulting in a decline in these errors to 2.5% of implants as compared to 17% in our previous publication using the fiducial-less method and 4% using fiducial-based methods of DBS lead placement.
在这项研究中，我们描述了一种通过在进入点放置套管来优化无框架脑深部刺激（DBS）导联放置准确性的技术，以预测完全插入器械的位置。这允许在穿透深部灰质之前实时纠正误差。
我们前瞻性地收集了 28 名患者 40 个导联的无框架无基准 DBS 手术中径向误差的数据。一旦将 Nexframe 与目标对齐，就将套管通过 BenGun 的中心通道插入，直到它穿过脑皮质表面并获得低剂量 O 臂旋转。使用沿成像套管长度的 2 个点，将轨迹线投影到目标深度。如果可以改善导联位置，则将套管通过 BenGun 中的另一条轨道插入到目标深度。在术中微电极记录和临床评估后，再次获得 O 臂旋转以比较插入导联的位置与套管放置时预测的位置。
套管放置的预测和实际植入物的平均径向差异为 0.75 ± 0.64 毫米。套管放置的预测在 33%的情况下识别出潜在的临床显著误差（平均 2.07 ± 0.73 毫米），这些误差在使用替代 BenGun 轨道校正后减少到 1.33 ± 0.66 毫米（p = 0.02）。所有 40 个导联的最终目标到植入物误差为 1.20 ± 0.52 毫米，只有 2.5%的误差大于 2.5 毫米。
套管放置技术可减少大误差（>2.5 毫米），与无基准方法的 17%和基于基准的 DBS 导联放置方法的 4%相比，这些误差减少到植入物的 2.5%。
