Intraoperative Computed Tomography for Registration of Stereotactic Frame in Frame-Based Deep Brain Stimulation

Abstract BACKGROUND: The efficacy of deep brain stimulation (DBS) is highly dependent on the accuracy of lead placement. OBJECTIVE: To describe the use of intraoperative computed tomography (iCT) to confirm lead location before surgical closure and to study the accuracy of this technique. METHODS: Fifteen patients underwent awake microelectrode-guided DBS surgery in a stereotactic frame. A portable iCT scanner (Medtronic O-arm) was positioned around the patient's head throughout the procedure and was used to confirm lead location before fixation of the lead to the skull. Images were computationally fused with preoperative magnetic resonance imaging (MRI), and lead tip coordinates with respect to the midpoint of the anterior commissure-posterior commissure line were measured. Tip coordinates were compared with those obtained from postoperative MRI. RESULTS: iCT was integrated into standard frame-based microelectrode-guided DBS surgery with a minimal increase in surgical time or complexity. Technically adequate 2-dimensional and 3-dimensional images were obtained in all cases. Head positioning and fixation techniques that allow unobstructed imaging are described. Lead tip measurements on iCT fused with preoperative MRI were statistically indistinguishable from those obtained with postoperative MRI. CONCLUSION: iCT can be easily incorporated into standard DBS surgery, replaces the need for C-arm fluoroscopy, and provides accurate intraoperative 3-dimensional confirmation of electrode tip locations relative to preoperative images and surgical plans. iCT fused to preoperative MRI may obviate the need for routine postoperative MRI in DBS surgery. Technical nuances that must be mastered for the efficient use of iCT during DBS implantation are described.

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Effect of Intraoperative Computed Tomography in Microelectrode Recording during Frameless Stereotactic Deep Brain Stimulation for Parkinson Disease

World Neurosurgery ◽

10.1016/j.wneu.2021.03.026 ◽

2021 ◽

Author(s):

Ying-Fa Chen ◽

Yang-Pei Chang ◽

Wu-Fu Chen ◽

Wei-Che Lin ◽

Yung-Yee Chang ◽

...

Keyword(s):

Computed Tomography ◽

Deep Brain Stimulation ◽

Parkinson Disease ◽

Brain Stimulation ◽

Microelectrode Recording ◽

Intraoperative Computed Tomography ◽

Deep Brain

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Implementation of Intraoperative Computed Tomography for Deep Brain Stimulation: Pitfalls and Optimization of Workflow, Accuracy, and Radiation Exposure

World Neurosurgery ◽

10.1016/j.wneu.2018.12.079 ◽

2019 ◽

Vol 124 ◽

pp. e252-e265

Author(s):

Barbara Carl ◽

Miriam Bopp ◽

Marko Gjorgjevski ◽

Carina Oehrn ◽

Lars Timmermann ◽

...

Keyword(s):

Computed Tomography ◽

Deep Brain Stimulation ◽

Radiation Exposure ◽

Brain Stimulation ◽

Intraoperative Computed Tomography ◽

Deep Brain

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Accuracy of Postoperative Computed Tomography and Magnetic Resonance Image Fusion for Assessing Deep Brain Stimulation Electrodes

Neurosurgery ◽

10.1227/neu.0b013e318218c7ae ◽

2011 ◽

Vol 69 (1) ◽

pp. 207-214 ◽

Cited By ~ 33

Author(s):

Nova B Thani ◽

Arul Bala ◽

Gary B Swann ◽

Christopher R P Lind

Keyword(s):

Computed Tomography ◽

Deep Brain Stimulation ◽

Magnetic Resonance ◽

Brain Stimulation ◽

Surrogate Marker ◽

Intraoperative Mri ◽

Fusion Algorithm ◽

Anatomic Location ◽

Stereotactic Frame ◽

Deep Brain

Abstract BACKGROUND: Knowledge of the anatomic location of the deep brain stimulation (DBS) electrode in the brain is essential in quality control and judicious selection of stimulation parameters. Postoperative computed tomography (CT) imaging coregistered with preoperative magnetic resonance imaging (MRI) is commonly used to document the electrode location safely. The accuracy of this method, however, depends on many factors, including the quality of the source images, the area of signal artifact created by the DBS lead, and the fusion algorithm. OBJECTIVE: To calculate the accuracy of determining the location of active contacts of the DBS electrode by coregistering postoperative CT image to intraoperative MRI. METHODS: Intraoperative MRI with a surrogate marker (carbothane stylette) was digitally coregistered with postoperative CT with DBS electrodes in 8 consecutive patients. The location of the active contact of the DBS electrode was calculated in the stereotactic frame space, and the discrepancy between the 2 images was assessed. RESULTS: The carbothane stylette significantly reduces the signal void on the MRI to a mean diameter of 1.4 ± 0.1 mm. The discrepancy between the CT and MRI coregistration in assessing the active contact location of the DBS lead is 1.6 ± 0.2 mm, P < .001 with iPlan (BrainLab AG, Erlangen, Germany) and 1.5 ± 0.2 mm, P < .001 with Framelink (Medtronic, Minneapolis, Minnesota) software. CONCLUSION: CT/MRI coregistration is an acceptable method of identifying the anatomic location of DBS electrode and active contacts.

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