A novel re-attachable stereotactic frame for MRI-guided neuronavigation and its validation in a large animal and human cadaver model

Abstract

Objective. Stereotactic frame systems are the gold-standard for stereotactic surgeries, such as implantation of deep brain stimulation (DBS) devices for treatment of medically resistant neurologic and psychiatric disorders. However, frame-based systems require that the patient is awake with a stereotactic frame affixed to their head for the duration of the surgical planning and implantation of the DBS electrodes. While frameless systems are increasingly available, a reusable re-attachable frame system provides unique benefits. As such, we created a novel reusable MRI-compatible stereotactic frame system that maintains clinical accuracy through the detachment and reattachment of its stereotactic devices used for MRI-guided neuronavigation. Approach. We designed a reusable arc-centered frame system that includes MRI-compatible anchoring skull screws for detachment and re-attachment of its stereotactic devices. We validated the stability and accuracy of our system through phantom, in vivo mock-human porcine DBS-model and human cadaver testing. Main results. Phantom testing achieved a root mean square error (RMSE) of 0.94 ± 0.23 mm between the ground truth and the frame-targeted coordinates; and achieved an RMSE of 1.11 ± 0.40 mm and 1.33 ± 0.38 mm between the ground truth and the CT- and MRI-targeted coordinates, respectively. In vivo and cadaver testing achieved a combined 3D Euclidean localization error of 1.85 ± 0.36 mm (p < 0.03) between the pre-operative MRI-guided placement and the post-operative CT-guided confirmation of the DBS electrode. Significance. Our system demonstrated consistent clinical accuracy that is comparable to conventional frame and frameless stereotactic systems. Our frame system is the first to demonstrate accurate relocation of stereotactic frame devices during in vivo MRI-guided DBS surgical procedures. As such, this reusable and re-attachable MRI-compatible system is expected to enable more complex, chronic neuromodulation experiments, and lead to a clinically available re-attachable frame that is expected to decrease patient discomfort and costs of DBS surgery002E

Orientation-selective and directional deep brain stimulation in swine assessed by functional MRI at 3T

“…Preoperative imaging included a 3D-MPRAGE (1 mm isotropic resolution, FOV 25.6 × 25.6 cm, number of slices = 176, TR/TE: 1900/2.93 ms, flip angle = 9°). These images were brought into Slicer ( http://www.slicer.org ) ( Fedorov et al, 2012 ), registered with localization markers on the stereotactic frame using the SimpleStereotactic Slicer extension (J. Jacobs, UW Madison) ( Edwards et al, 2018 ), and registered to a swine atlas ( Félix et al, 1999 ; Saikali et al, 2010 ) using the Landmark Registration module (nonlinear, affine) in Slicer. An example is shown in Fig.…”

Development and in vivo assessment of a novel MRI‐compatible headframe system for the ovine animal model

“…Despite these studies, to our knowledge, only a few stereotactic head frames were shown to be compatible with the conventional Cosman Roberts Wells (CRW) Stereotactic System © . Most of the head frames were employed in studies with pig models, 9,12,13 with a design that could not easily be scaled to the ovine model, and was not suitable for clinical use, as reported by Oheim et al 10 …”

“…The stereotactic surgical approach has also been used for continuous monitoring of the electroencephalographic activity through the insertion of needles, as shown by Perentos et al 11 Despite these studies, to our knowledge, only a few stereotactic head frames were shown to be compatible with the conventional Cosman Roberts Wells (CRW) Stereotactic System © . Most of the head frames were employed in studies with pig models, 9,12,13 with a design that could not easily be scaled to the ovine model, and was not suitable for clinical use, as reported by Oheim et al 10 The present work focuses on the design of a new head frame system (HFS) for the ovine model, suitable for MRI and CT studies, designed to work with more widely available CRW Stereotactic System © . The new HFS was developed following clinical requirements for neurosurgical applications.…”

DeepNavNet: Automated Landmark Localization for Neuronavigation

“…Imaging technologies such as magnetic resonance imaging (MRI) provide visualization of brain structures that enable neurosurgeons to plan accurate and safe surgical trajectories (Edwards et al, 2017). In MRI-guided functional neurosurgery, image space is registered to a stereotactic head frame with a built-in three-dimensional (3D) coordinate system using stereotactic planning software (Edwards et al, 2018). This software allows surgeons to view the neuroimaging data to derive 3D coordinates of the brain target(s) to plan the surgical trajectory path(s).…”

“…This software allows surgeons to view the neuroimaging data to derive 3D coordinates of the brain target(s) to plan the surgical trajectory path(s). This approach has been predominantly used to implant electrodes for deep brain stimulation and to deliver focused ultrasonic ablation, both of which provide therapeutic relief of debilitating movement and psychiatric disorders (Elias et al, 2016;Edwards et al, 2017Edwards et al, , 2018.…”