Clinical Accuracy of a Customized Stereotactic Platform for Deep Brain Stimulation after Accounting for Brain Shift

D’Haese, Pierre-François; Pallavaram, Srivatsan; Konrad, Peter E.; Neimat, Joseph S.; Fitzpatrick, J. Michael; Dawant, Benoît M.

doi:10.1159/000271823

Cited by 59 publications

(44 citation statements)

References 29 publications

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“…The frame-based systems include the Leksell system (Elekta Instruments Inc., Sweden) [18,31,41], the Zamorano-Dujovny system (Stryker-Leibinger Inc., Germany) [19], the Riechert-Mundinger system (Innomed Pte Ltd., Germany) [20], the Cosman-Roberts-Wells system (Radionics Inc., USA) [17,39,42] and the Neuromate robot (Renishaw Inc., UK) [43]. The frameless systems include NexFrame (Image-Guided Neurologics Inc., USA) [21,26,32] and the STarFix microTargeting Platform (FHC Inc., USA) [22,27,44]. The iMRI-guided system means the ClearPoint SmartFrame (MRI Interventions Inc., USA) [35].…”

Section: Resultsmentioning

confidence: 99%

“…In the early days, only frame-based stereotactic systems were used for electrode implantation [17,18,19,20]. Nowadays, various newly developed systems integrated with novel techniques such as optical navigation and interventional magnetic resonance imaging (iMRI) have entered the clinical theater, making the electrode implantation operation increasingly diverse [15,21,22,23], but the information on the targeting accuracy of different stereotactic systems is fragmented and mainly appears in various clinical reports [24,25,26,27]. An early systematic study on this topic is that published in 1994 by Maciunas et al [24].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Review on Factors Affecting Targeting Accuracy of Deep Brain Stimulation Electrode Implantation between 2001 and 2015

Li¹,

Zhang

Yan

et al. 2016

Stereotact Funct Neurosurg

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Background: Accurate implantation of a depth electrode into the brain is of the greatest importance in deep brain stimulation (DBS), and various stereotactic systems have been developed for electrode implantation. However, an updated analysis of depth electrode implantation in the modern era of DBS is lacking. Objective: This study aims at providing an updated review on targeting accuracy of DBS electrode implantation by analyzing contemporary DBS electrode implantation operations from the perspective of precision engineering. Methods: Eligible articles with information on targeting accuracy of DBS electrode implantation were searched in the PubMed database. Results: An average targeting error of DBS electrode implantation is reported to decrease toward 1 mm; the standard deviation of targeting error is decreasing toward 0.5 mm. Targeting accuracy is not only found to be affected by individual surgical steps, but also systematically affected by the architecture of the implantation operation. Conclusion: A systematic strategy should be adopted to further improve the targeting accuracy of depth electrode implantation. Attention should be paid to optimizing the whole electrode implantation operation, which can help minimize error accumulation or amplification throughout the serially connected procedures for DBS electrode implantation.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Review on Factors Affecting Targeting Accuracy of Deep Brain Stimulation Electrode Implantation between 2001 and 2015

Li¹,

Zhang

Yan

et al. 2016

Stereotact Funct Neurosurg

View full text Add to dashboard Cite

show abstract

“…12,13 When compared with the Nexframe (Medtronic), STarFix has been shown to be more accurate. 2 Given the similar demands for accuracy and precision required for targeting tumors and epileptogenic foci, we believe that particular LITT cases could benefit from this technology based on our experience with the platform. Our success in incorporating STarFix mT frames into the LITT workflow serves as proof of concept for future endeavors to treat difficult-to-access lesions in critical brain regions.…”

Section: Discussionmentioning

confidence: 99%

Utilizing personalized stereotactic frames for laser interstitial thermal ablation of posterior fossa and mesiotemporal brain lesions: a single-institution series

Dadey

Kamath

Smyth

et al. 2016

FOC

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OBJECTIVE The precision of laser probe insertion for interstitial thermal therapy of deep-seated lesions is limited by the method of stereotactic guidance. The objective of this study was to evaluate the feasibility of customized STarFix 3D-printed stereotactic platforms to guide laser probe insertion into mesiotemporal and posterior fossa targets. METHODS The authors conducted a retrospective review of 5 patients (12–55 years of age) treated with laser interstitial thermal therapy (LITT) in which STarFix platforms were used for probe insertion. Bone fiducials were implanted in each patient's skull, and subsequent CT scans were used to guide the design of each platform and incorporate desired treatment trajectories. Once generated, the platforms were mounted on the patients' craniums and used to position the laser probe during surgery. Placement of the laser probe and the LITT procedure were monitored with intraoperative MRI. Perioperative and follow-up MRI were performed to identify and monitor changes in target lesions. RESULTS Accurate placement of the laser probe was observed in all cases. For all patients, thermal ablation was accomplished without intraoperative complications. Of the 4 patients with symptomatic lesions, 2 experienced complete resolution of symptoms, and 1 reported improved symptoms compared with baseline. CONCLUSIONS Customized stereotactic platforms were seamlessly incorporated into the authors' previously established LITT workflow and allowed for accurate treatment delivery.

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“…More importantly, the frame can be quickly detached and reattached to the anchors, leaving an unobstructed field of view to the craniotomy. If a rather limited number of depth electrodes is to be implanted, the less complex StarFix design for DBS [10,11,12,13] could be used instead for increased simplicity of use. …”

Section: Discussionmentioning

confidence: 99%

“…Limited intraoperative adjustments (in the order of millimeters to centimeters) to the trajectory can be implemented by pivot and rotate movements in the NexFrame or by inserting additional offsetting adapters in the StarFix microTargeting (mT) platform. Accordingly, while appropriate for deep brain stimulation (DBS) lead implantation procedures [11,12] and for the placement of up to 2 hippocampal epilepsy depth electrodes [13], the Nexframe and StarFix mT platform devices are not currently capable of supporting multiple passes with one single fixture, as would be required for SEEG depth electrode implantation.…”

Section: Introductionmentioning

confidence: 99%

A Personalized Stereotactic Fixture for Implantation of Depth Electrodes in Stereoelectroencephalography

Bălănescu

Franklin²,

Ciurea

et al. 2014

Stereotact Funct Neurosurg

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Background: The stereoelectroencephalographic (SEEG) implantation procedures still represent a challenge due to the intrinsic complexity of the method and the number of depth electrodes required. Objectives: We aim at designing and evaluating the accuracy of a custom stereotactic fixture based on the StarFix™ technology (FHC Inc., Bowdoin, ME) that significantly simplifies and optimizes the implantation of depth electrodes used in presurgical evaluation of patients with drug-resistant epilepsy. Methods: Fiducial markers that also serve as anchors for the fixture are implanted into the patient's skull prior to surgery. A 3D fixture model is designed within the surgical planning software, with the planned trajectories incorporated in its design, aligned with the patient's anatomy. The stereotactic fixture is built using 3D laser sintering technology based on the computer-generated model. Bilateral rectangular grids of guide holes orthogonal to the midsagittal plane and centered on the midcommissural point are incorporated in the fixture design, allowing a wide selection of orthogonal trajectories. Up to two additional grids can be accommodated for targeting structures where oblique trajectories are required. The frame has no adjustable parts, this feature reducing the risk of inaccurate coordinate settings while simultaneously reducing procedure time significantly. Results: We have used the fixture for the implantation of depth electrodes for presurgical evaluation of 4 patients with drug-resistant focal epilepsy, with nearly 2-fold reduction in the duration of the implantation procedure. We have obtained a high accuracy with a submillimetric mean positioning error of 0.68 mm for the anchor bolts placed at the trajectory entry point and 1.64 mm at target. Conclusions: The custom stereotactic fixture design greatly simplifies the planning procedure and significantly reduces the time in the operating room, while maintaining a high accuracy.

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Clinical Accuracy of a Customized Stereotactic Platform for Deep Brain Stimulation after Accounting for Brain Shift

Cited by 59 publications

References 29 publications

Review on Factors Affecting Targeting Accuracy of Deep Brain Stimulation Electrode Implantation between 2001 and 2015

Review on Factors Affecting Targeting Accuracy of Deep Brain Stimulation Electrode Implantation between 2001 and 2015

Utilizing personalized stereotactic frames for laser interstitial thermal ablation of posterior fossa and mesiotemporal brain lesions: a single-institution series

A Personalized Stereotactic Fixture for Implantation of Depth Electrodes in Stereoelectroencephalography

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