Accuracy of Customized Miniature Stereotactic Platforms

In this study, a new system was evaluated for implanting deep-brain stimulators based on a one-piece platform for each trajectory customized from a preoperative planning image. During surgery, the platform is attached to skull-implanted posts that extend through the scalp. The platform acts as a miniature stereotactic frame to provide guidance for parallel cannulas as they are advanced through a burr hole to the target. Accuracy is determined from a postoperative CT. For each implantation, the distance between the position observed in the postoperative image and the position calculated relative to the platform from the preoperative image is our measure of error. Because this measure incorporates the surgical error of electrode anchoring, brain shift between preoperative and postoperative scanning, and error in the measurement of the position of the electrode in CT, it will tend to overestimate the true error. The mean error was 2.8 mm for 20 implantations. These data reflect favorably the accuracy of this system when compared with others.

[1]  P. Reed.  Stereotactic neurosurgery , 2017, Neurosurgery clinics of North America.

[2]  R J Maciunas,et al.  An independent application accuracy evaluation of stereotactic frame systems. , 1992, Stereotactic and functional neurosurgery.

[3]  R.J. Maciunas,et al.  An automatic technique for finding and localizing externally attached markers in CT and MR volume images of the head , 1996, IEEE Transactions on Biomedical Engineering.

[4]  Robert J. Maciunas,et al.  Registration of head volume images using implantable fiducial markers , 1997, IEEE Transactions on Medical Imaging.

[5]  R. J. Allan,et al.  Neurophysiological identification of the subthalamic nucleus in surgery for Parkinson's disease , 1998, Annals of neurology.

[6]  Vincent Dousset,et al.  Lack of agreement between direct magnetic resonance imaging and statistical determination of a subthalamic target: the role of electrophysiological guidance. , 2002, Journal of neurosurgery.

[7]  P. Starr,et al.  Implantation of deep brain stimulators into the subthalamic nucleus: technical approach and magnetic resonance imaging-verified lead locations. , 2002, Journal of neurosurgery.

[8]  W. Hamel,et al.  Documentation of electrode localization , 2002, Movement disorders : official journal of the Movement Disorder Society.

[9]  Alexandre Mendes,et al.  Intraoperative micro‐ and macrostimulation of the subthalamic nucleus in Parkinson's disease , 2002, Movement disorders : official journal of the Movement Disorder Society.

[10]  J. Michael Fitzpatrick,et al.  Method for placing deep-brain stimulators , 2003, SPIE Medical Imaging.

[11]  A. Benabid,et al.  Deep brain stimulation: what does it offer? , 2003, Advances in neurology.

[12]  R. Turner,et al.  Surgery of the subthalamic nucleus: use of movement-related neuronal activity for surgical navigation. , 2003, Neurosurgery.

[13]  J. Volkmann,et al.  Deep brain stimulation of the subthalamic nucleus for Parkinson's disease: a therapy approaching evidence-based standards , 2003, Journal of Neurology.