Accuracy in Frame-Based and Frameless Stereotaxy

Kitchen, Neil; Lemieux, Louis; Thomas, D. G. T.

doi:10.1159/000100637

Cited by 53 publications

(22 citation statements)

References 11 publications

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“…However, all of the published clinical accuracy studies and the majority of the laboratory studies to date have used adhesive 'doughnut' markers or anatomical fiducials [4][5][6][8][9][10][11][12][13][14]. There are several factors which contribute to inaccuracy when using this type of fiducial marker, in- In the first three cases, only localization error was measured.…”

Section: Discussionmentioning

confidence: 99%

“…This is the minimum number of points for paired-point registration, there is no redundancy, and the points are all coplanar, making the registration solution suboptimal. It has been shown that distributing fiducials throughout the volume of interest increases registration accuracy [14]. Registration is the 'Achilles' heel' of image-guided surgery, so misregistration can have the largest adverse effect.…”

Section: Hendersonmentioning

confidence: 99%

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Frameless Localization for Functional Neurosurgical Procedures: A Preliminary Accuracy Study

Henderson

2004

Stereotact Funct Neurosurg

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Background: Targeting for functional stereotactic procedures is traditionally carried out in a noninteractive fashion, without real-time positional feedback. In addition, stereotactic frames are uncomfortable for patients and may impede intraoperative neurological evaluation. As an initial step toward a fully frameless approach to functional surgery, we have investigated the use of an image-guided microdrive coupled to a stereotactic frame system. Methods: For initial laboratory tests, a stereotactic phantom was imaged using high-resolution CT scanning. Three representative targets were chosen within the phantom. Targeting was carried out in the usual fashion using the StealthStation planning suite, utilizing the Radionics CRW system. An LED-equipped reference arc was attached to the CRW base ring. Registration of the base ring was accomplished using a spherical probe. A custom-built microdrive was fitted with an LED array, mounted on the CRW arc and tracked by the StealthStation. The distance between the Stealth real-time localization and the CRW localization was measured on-screen. To evaluate the accuracy of the system in the operating room, a similar procedure was carried out in 13 functional neurosurgical operations (pallidotomy or deep brain stimulator placement). Results: Errors of localization in the laboratory setting ranged from 0.53 to 0.70 mm. In 11 operative cases, the average difference between the CRW localization and the Stealth localization was 1.77 mm. In the remaining 2 cases, equipment malfunction prevented measurement of localization error. Conclusions: Frameless image-guided localization compares favorably to targeting performed noninteractively. In addition, real-time positional feedback confers advantages in target region visualization and confidence in placement of lesions and stimulators for functional procedures. With small improvements in accuracy and system reliability, fully frameless functional procedures could be safely carried out.

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Section: Discussionmentioning

confidence: 99%

Section: Hendersonmentioning

confidence: 99%

Frameless Localization for Functional Neurosurgical Procedures: A Preliminary Accuracy Study

Henderson

2004

Stereotact Funct Neurosurg

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“…The positions of these points are then correlated with the corresponding surface from image data, and an estimate of the residual error is given 194 . This method is time consuming 83 . Methods to speed up data collection include pointers with automated surface-contact detection (Softouch, Brainlab, Heimstetten, Germany), a robot-guided registration tool 50 and continuous collection of surface points 69,79 .…”

Section: Surface Registrationmentioning

confidence: 99%

Image-to-patient registration techniques in head surgery

Eggers

Mühling

Marmulla

2006

International Journal of Oral and Maxillofacial Surgery

204

135

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“…The development of techniques for neuronavigation rendered it possible to perform stereotactic brain surgery without a conventional frame fixed to the skull bone (frameless stereotaxy) [6,7] .…”

Section: Introductionmentioning

confidence: 99%

Comparison of Accuracy and Precision between Frame-Based and Frameless Stereotactic Navigation for Deep Brain Stimulation Electrode Implantation

Bjartmarz

Rehncrona

2007

Stereotact Funct Neurosurg

171

117

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The accuracy and precision of frameless neuronavigation as compared to conventional frame-based stereotaxy for implantation of deep brain stimulation (DBS) electrodes were studied in 14 patients with essential tremor. DBS electrodes were implanted bilaterally in the ventrolateral thalamus [ventrointermediate nucleus (VIM)] in one procedure. Frameless neuronavigation was used on one side and the conventional frame-based technique on the other. Targeting was guided by MRI and CT imaging. Intraoperative stereotactic plain X-ray verified final electrode positions and electrode deviations from the planned target were measured. Clinical outcome was evaluated with the Essential Tremor Rating Scale. Thirteen of the patients were eligible for measuring electrode deviations and 10 of them were available for a clinical follow-up. Electrode deviations from target were larger using the frameless technique in the medial-lateral (x: 1.9 ± 1.3 mm) and anterior-posterior (y:0.9 ± 0.8 mm) directions as compared to the frame-based technique (x: 0.5 ± 0.5 and y: 0.4 ± 0.4 mm) but similar in the superior-inferior direction (z). The vector of deviation was 2.5 ± 1.4 mm with the frameless technique and 1.2 ± 0.6 with the frame-based technique. The differences were statistically significant (p < 0.05–0.001). The dispersion was larger with the frameless technique as represented by the larger standard deviations in all three planes. At clinical follow-ups, tremor reduction was similar irrespective of the implantation technique. It is concluded that conventional frame-based stereotaxy has higher accuracy/precision for hitting a small brain target than the frameless technique. However, the difference is relatively small and does not influence the clinical result of DBS electrode implantations in the VIM when treating tremor.

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Accuracy in Frame-Based and Frameless Stereotaxy

Cited by 53 publications

References 11 publications

Frameless Localization for Functional Neurosurgical Procedures: A Preliminary Accuracy Study

Frameless Localization for Functional Neurosurgical Procedures: A Preliminary Accuracy Study

Image-to-patient registration techniques in head surgery

Comparison of Accuracy and Precision between Frame-Based and Frameless Stereotactic Navigation for Deep Brain Stimulation Electrode Implantation

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