ObjectivesWe review our cases of hardware problems requiring revision surgery and consider the technical aspects of revising the electrodes, including a frameless technique using the Renishaw Guide tubes.DesignRetrospective Review.SubjectsChildren (≤18 years old) who presented with hardware problems following implantation of a DBS for dystonia at King’s College Hospital between May 2005 and April 2018.MethodsInformation was obtained from a prospectively kept database.ResultsOf 166 paediatric patients with DBS, 25 patients had hardware problems, and of these 21 (13%) patients had specifically electrode problems requiring replacement/revision of one or more electrodes. 7 patients had high impedances requiring revision, without obvious lead migration of fracture. 7 patients had lead migration and a further 7 patients had a lead fracture with or without lead migration. 15 patients had original DBS insertion with the Leksell Stereotactic System utilising the Medtronic Stimlock for lead fixation. 6 patients had DBS inserted with the Renishaw Sterotactic Robot and utilised the Renishaw Guide Tubes, in these patients who required lead replacement it was possible to revise the electrode without using stereotactic apparatus. As the guide tubes are implanted in the correct trajectory it is possible to measure the distance required to advance/implant the lead within this to target without the need for full stereotactic reimplantation.ConclusionsElectrode dysfunction is relatively common in children with DBS and a systematic approach is required to identify the cause. When an electrode requires repositioning or replacement, the procedure can be performed in the conventional manner with a stereotactic frame, or freehand without a frame if a Renishaw Guide tube is used at time of first insertion.
ObjectivesTo quantify the accuracy of DBS electrode implantation for movement disorder in paediatric patients utilising the neuroinspire™ software and neuromate® robot.DesignRetrospective, single-centre, cohort study.SubjectsFifteen patients with dystonia (67% female; median age 11 years, range 8–18 years) underwent intervention since May 2017.MethodsDBS procedures were planned on the neuroinspire™ software and electrodes were implanted using the Renishaw neuromate® robot and Renishaw guide tubes and secured with a dog-bone plate under general anaesthetic. Post-operative CT imaging with the intra-operative O-arm was fused to pre-operative imaging. Planned entry and target coordinates were compared to actual entry and final target coordinates in order to obtain absolute and directional errors in x (medial-lateral), y (anterior-posterior) and z (dorsal-ventral) planes. Euclidean error was calculated for each electrode. Wilcoxon signed-rank test was used to analyse error.ResultsBilateral GPi were targeted and Medtronic DBS systems were implanted for each patient (n=30). Overall median Euclidean error for electrode implantation was 2.13 mm (range, 0.71–4.85; p<0.001). No discrepancy between left- and right-sided electrodes was seen (p=0.346). Absolute errors in x (med 1.25 mm, range 0.10–4.10), y (med 0.80 mm, range 0–2.70) and z (med 1.45 mm, range 0–3.90) planes were individually significant (p<0.001). On overall anterior displacement of leads was observed (med 0.55+0.85 mm, p=0.001) but there was no significant directional bias in x (p=0.219) or z (p=0.077) planes.ConclusionsWe observed an improvement in the discrepancy seen between planned and actual lead location compared to a previously reported series using the Leksell frame in a similar cohort. Addressing possible compounding factors such as drilling techniques and electrode fixation should increase accuracy further. The neuromate® Robot is a reliable and accurate alternative to the Leksell frame.
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