Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal.
Department of Neurosurgery, Centro Hospitalar Universitário de São João, Porto, Portugal.
Acta Neurochir (Wien). 2024 Aug 7;166(1):328. doi: 10.1007/s00701-024-06214-8.
In the absence of an intraoperative CT or MRI setup, post-implantation confirmation of electrode position in deep brain stimulation (DBS) requires patient transportation to the radiology unit, prolonging surgery time. This project aims to validate intraoperative 3D fluoroscopy (3DF), a widely available tool in Neurosurgical units, as a method to determine final electrode position.
We performed a retrospective study including 64 patients (124 electrodes) who underwent DBS at our institution. Intraoperative 3DF after electrode implantation and postoperative volumetric CT were acquired. The Euclidean coordinates of the electrode tip displayed in both imaging modalities were determined and inter-method deviations were assessed. Pneumocephalus was quantified and its potential impact in determining the electrode position analyzed. Finally, 3DF and CT-imposed exposure to radiation was compared.
The difference between the electrode tip estimated by 3DF and CT was 0.85 ± 0.03 mm, and not significantly different (p = 0.11 for the distance to MCP assessed by both methods), but was, instead, highly correlated (p = 0.91; p < 0.0001). Even though pneumocephalus was larger in 3DF (6.89 ± 1.76 vs 5.18 ± 1.37 mm in the CT group, p < 0.001), it was not correlated with the difference in electrode position measured by both techniques (p = 0.17; p = 0.06). Radiation exposure from 3DF is significantly lower than CT (0.36 ± 0.03 vs 2.08 ± 0.05 mSv; p < 0.0001).
Intraoperative 3DF is comparable to CT in determining the final DBS electrode position. Being a method with fewer radiation exposure, less expensive, faster and that avoids patient transportation outside the operation room, it is a valid tool to replace postoperative CT.
在缺乏术中 CT 或 MRI 设备的情况下，深部脑刺激 (DBS) 植入后的电极位置确认需要将患者转运到放射科，从而延长手术时间。本项目旨在验证术中三维荧光透视 (3DF) 作为一种确定最终电极位置的方法，3DF 是神经外科单元中广泛使用的工具。
我们进行了一项回顾性研究，包括在我们机构接受 DBS 的 64 名患者（124 个电极）。在植入电极后进行术中 3DF 检查，并进行术后容积 CT 检查。确定两种成像方式下电极尖端的欧几里得坐标，并评估两种方法之间的偏差。量化了气颅，并分析了其对确定电极位置的潜在影响。最后，比较了 3DF 和 CT 产生的辐射暴露。
3DF 估计的电极尖端与 CT 的差异为 0.85±0.03mm，差异无统计学意义（两种方法评估的 MCP 距离差异为 p=0.11），但高度相关（p=0.91;p<0.0001）。尽管 3DF 中的气颅更大（3DF 组为 6.89±1.76mm，CT 组为 5.18±1.37mm，p<0.001），但与两种技术测量的电极位置差异无关（p=0.17;p=0.06）。3DF 的辐射暴露明显低于 CT（0.36±0.03 与 2.08±0.05mSv；p<0.0001）。
术中 3DF 与 CT 在确定最终 DBS 电极位置方面具有可比性。作为一种具有较少辐射暴露、更经济、更快且避免患者在手术室外转运的方法，它是一种替代术后 CT 的有效工具。
