Customized, Miniature Rapid-Prototype Stereotactic Frames for Use in Deep Brain Stimulator Surgery: Initial Clinical Methodology and Experience from 263 Patients from 2002 to 2008

Konrad, Peter E.; Neimat, Joseph S.; Yu, Hong; Kao, Chris; Remple, Michael S.; D’Haese, Pierre-François; Dawant, Benoît M.

doi:10.1159/000322276

Cited by 76 publications

(69 citation statements)

References 45 publications

(21 reference statements)

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“…Indeed, this has been shown to result in shorter operative times for DBS procedures. 9 In this study, we found that the mean total operative time, accounting for fiducial placement and ablation, trended toward shorter average time, 19 minutes less than our institutional mean for LITT, although this was based on a small sample size and without an appropriately matched control group.…”

Section: Discussionmentioning

confidence: 58%

“…LITT trajectories to the posterior fossa and medial temporal lobe are more feasible with the Mini-Bolt (Monteris), but the accuracy of this approach is limited by the stability of the trajectory guide for the various neuronavigation systems, which often cannot withstand the force of a handheld drill. The accuracy of STarFix platforms has been shown in its applications to DBS, 9 with STarFix providing equally effective probe implantation when compared with conventional Zamorano-Dujovny frames. 12,13 When compared with the Nexframe (Medtronic), STarFix has been shown to be more accurate.…”

Section: Discussionmentioning

confidence: 99%

“…Bone fiducials, by serving as fixed anchor points, may allow for the planning of highly accurate and stable treatment trajectories. 19 STarFix mT platforms have been successfully used for deep brain stimulation (DBS) 9 and for epilepsy monitoring; 1,18 however, to date no studies have examined their application to LITT. In this paper we present a series of 5 patients who presented with intracranial lesions that were amenable to LITT with STarFix stereotactic guidance.…”

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confidence: 99%

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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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Section: Discussionmentioning

confidence: 58%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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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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“…The use of frameless or robotic techniques to bypass this limitation may become increasingly important in the future. 25 The third method is to alter the pulse sequence used, but this requires neurosurgeons to spend time optimizing the new sequences and gaining confidence with its use.…”

Section: Discussionmentioning

confidence: 99%

Magnetic resonance imaging of the subthalamic nucleus for deep brain stimulation

Chandran¹,

Bynevelt

Lind

2016

JNS

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F uture progress to refine targets for deep brain stimulation (DBS) is critically dependent on precise placement and verification of electrodes in the brain. No stereotactic target is of more clinical importance or more nuanced regarding its imaging than the subthalamic nucleus (STN). The STN is difficult to image because of its biconvex shape, small size, oblique spatial orientation in 3 planes, and its close proximity to the substantia nigra (SN).3 A high level of accuracy is required as the motor region of the STN is posterolateral, and unwanted stimulation side effects may occur as a result of direct stimulation or spread to the anteromedial nonmotor area and the adjacent corticospinal tract. 9,18,31,56 Current imaging of STN borders is difficult.Targeting of the STN has historically been performed indirectly; the neurosurgeon predicts the location of the STN based on coordinates derived from atlases. These coordinates have often been related to the midcommissural point, which was derived from x-ray ventriculography but also from CT and MRI. Retaining this indirect, coordinate-based approach has been attractive to neurosurgeons. Experience in using this approach has been handed down from the past and can be used even with modern noninvasive imaging, and targeting preferences can be easily communicated between surgeons. The problem with indirect targeting is that different patients have different STN sizes, shapes, and positions.38 Direct targeting is an attempt to locate the STN in each individual patient.Poor image quality on traditional 1.5 tesla (T) scanners and primitive pulse sequences that do not provide adequate contrast at the level of the STN have limited the progression of direct targeting in some centers. Also hindering the development of stereotactic MRI are concerns about image distortion with higher field strength; traditional stereotactic head frames and localizers are too bulky to permit the use of high-quality, multichannel MRI head coils.Despite these challenges, higher field strength scanners and new pulse sequences have improved image quality to a point that some groups have adopted direct targeting of the STN, based on MRI.3,9,37 Difficulty delineating the STN and spatial inaccuracy has resulted in reluctance from others to abandon adjuncts such as CT/MRI merge and intraoperative electrophysiology.Traditionally, T2-weighted imaging (T2WI) has been used to plan for direct targeting of the STN using a variety of imaging parameters (Fig. 1).9 Although T2WI is useful, it is difficult to clearly delineate the STN from the SN and, to a lesser extent, the zona incerta (ZI). 22,32,37 abbreviatioNs CNR = contrast-to-noise ratio; DBS = deep brain stimulation; DTI = diffusion tensor imaging; FA = fractional anisotropy; FGATIR = fast gray matter acquisition T1 IR; FLAIR = fluid attenuated IR; FLASH = fast low-angle shot; FSE = fast spin echo; GRE = gradient echo; IR = inversion recovery; NSA = number of signal averages; PSIR = phase-sensitive IR; QSM = quantitative susceptibility mapping; SE = spin ...

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“…[3,14,15]) but few are available commercially. The ones that are available are either very large like the stereotactic frame or they are individual for each patient [16,17]. Due to this a prototype has been developed in this project for positioning a surgical instrument to show how the uncertainty of the navigation process can be estimated based on principles of production metrology.…”

Section: A Mechanical Positioning System For the Drillmentioning

confidence: 99%

Assessing the risk of minimally-invasive surgery: a metrological approach

Nau

Pollmanns

Schmitt

2013

16th International Congress of Metrology

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Abstract. Principles of uncertainty evaluation for measurement processes and capability studies for production processes are established in many producing enterprises to ensure capable processes. Together with further quality management methods this allows to estimate and minimize the risk of producing defective parts and of taking wrong decisions about the part's conformity with its specification. This understanding is also desirable for a completely different field, for medical surgery. To quantify the risk of minimally invasive surgery for an individual patient, principles of metrology and production engineering are transferred to the medical domain and are exemplarily applied to minimally invasive surgery at the inner ear. It is shown how the main influencing factors, the uncertainty of the imaging and image processing and the uncertainty of the navigation process of the surgical instrument can be estimated with methods from production metrology. Furthermore, it is shown how these factors contribute to quantifying the patient's risk of a specific surgery by contributing to a therapeutic risk indicator (TRI).Abstract. Les principes et méthodes pour estimer l'incertitude de mesure et l'aptitude de procès de manufacture ont été établis dans beaucoup d'entreprises pour obtenir des procès capables. En combinaison avec d'autres méthodes de gestion de qualité, le risque de fabriquer des pièces endommagées et de prendre une décision non-fondée concernant la qualité d'une pièce peut être réduit. Ce concept est aussi souhaitable pour un autre domaine : les opérations chirurgicales mini-invasives. Les principes de métrologie et de technique de production sont transférés dans le domaine médical pour quantifier le risque d'une opération mini-invasive pour un patient, par exemple d'une opération mini-invasive de l'oreille interne. Ce travail montre comment les facteurs principaux, l'incertitude d'imagerie et l'incertitude de naviguer les instruments chirurgicaux, peuvent être estimés avec les principes de métrologie manufactures. En plus, cela montre comment ces facteurs contribuent à quantifier le risque d'une opération mini-invasive et à l'index thérapeutique de risque (TRI).

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Customized, Miniature Rapid-Prototype Stereotactic Frames for Use in Deep Brain Stimulator Surgery: Initial Clinical Methodology and Experience from 263 Patients from 2002 to 2008

Cited by 76 publications

References 45 publications

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

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

Magnetic resonance imaging of the subthalamic nucleus for deep brain stimulation

Assessing the risk of minimally-invasive surgery: a metrological approach

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