Hines Kevin, Matias Caio M, Leibold Adam, Sharan Ashwini, Wu Chengyuan
J Neurosurg. 2022 Jul 8;138(2):299-305. doi: 10.3171/2022.5.JNS22804. Print 2023 Feb 1.
Stereotactic surgical methods continue to advance technologically. Frameless transient fiducial registration (FTFR) systems have been developed and avoid the need to move or position a patient in a frame after already receiving registration imaging. One such system, Neurolocate, has recently become available as a robotic attachment for the Neuromate stereotactic robot. This study is the largest in the literature to evaluate the accuracy of frameless registration using Neurolocate versus frame-based registration (FBR) methods in both deep brain stimulation (DBS) and stereoelectroencephalography (SEEG). Additionally, the authors sought to reevaluate factors affecting accuracy in both procedures.
This study was a retrospective chart and imaging review of 88 consecutive procedures (involving 621 electrodes) implanting either DBS or SEEG at the authors' institution over a 5-year period from March 2015 to March 2020. Registration duration, radial target entry point, and Euclidean target implantation accuracies, as well as factors affecting accuracy, were recorded for each patient.
SEEG procedures included 38 patients and 525 implanted electrodes (294 using FBR and 231 using FTFR). DBS procedures included 50 patients and 96 implanted electrodes (65 using FBR and 31 using FTFR). Overall, FTFR registration was significantly more accurate (median 0.1 mm, IQR 0-0.4 mm) compared with FBR (median 1.3 mm, IQR 0.9-1.5 mm; p = 0.04). Likewise, FTFR had a significantly shorter duration of registration (median 84 minutes, IQR 77.3-95.3 minutes) when compared with FBR (median 110.5 minutes, IQR 107.3-138 minutes; p = 0.02). No significant differences were found when examining the radial entry point and Euclidean target implantation errors of each method.
FTFR with the Neurolocate system represents a technique that may decrease operative time while maintaining the high accuracy previously demonstrated by other stereotactic methods, despite an initial surgeon learning curve. It should be investigated in future studies to continue to improve stereotactic accuracies in neurosurgery.
立体定向手术方法在技术上不断进步。无框架临时基准点配准（FTFR）系统已被开发出来，避免了在患者已经接受配准成像后再将其移入或定位在框架中的需要。一种这样的系统，Neurolocate，最近作为一种机器人附件可用于Neuromate立体定向机器人。本研究是文献中规模最大的一项，旨在评估在深部脑刺激（DBS）和立体定向脑电图（SEEG）中使用Neurolocate进行无框架配准与基于框架的配准（FBR）方法的准确性。此外，作者试图重新评估这两种手术中影响准确性的因素。
本研究是一项回顾性图表和影像学回顾，对2015年3月至2020年3月期间作者所在机构连续进行的88例植入DBS或SEEG的手术（涉及621个电极）进行分析。记录每位患者的配准持续时间、径向靶点进入点、欧几里得靶点植入准确性以及影响准确性的因素。
SEEG手术包括38例患者和525个植入电极（294个使用FBR，231个使用FTFR）。DBS手术包括50例患者和96个植入电极（65个使用FBR，31个使用FTFR）。总体而言，与FBR（中位数1.3毫米，四分位间距0.9 - 1.5毫米；p = 0.04）相比，FTFR配准显著更准确（中位数0.1毫米，四分位间距0 - 0.4毫米）。同样，与FBR（中位数110.5分钟，四分位间距107.3 - 138分钟；p = 0.02）相比，FTFR的配准持续时间显著更短（中位数84分钟，四分位间距77.3 - 95.3分钟）。在检查每种方法的径向进入点和欧几里得靶点植入误差时未发现显著差异。
使用Neurolocate系统的FTFR代表了一种技术，尽管有一个初步的外科医生学习曲线，但它可能会减少手术时间，同时保持其他立体定向方法先前证明的高精度。未来的研究应进一步探索以继续提高神经外科手术中的立体定向准确性。
