Deep Brain Stimulation of the Subthalamic Nucleus in Parkinson’s Disease: Usefulness of Intraoperative Radiological Guidance

Abstract

Background: In our stereotactic procedure, intraoperative radiological documentation of electrode localization is performed using the Stereoplan. The aim of the study was to evaluate its accuracy. Patients and Methods: Data of 20 consecutive patients, treated for Parkinson’s disease by implantation of deep brain stimulators into the subthalamic nucleus, were collected prospectively. During surgery, Stereoplan coordinates of the tip of the central macroelectrodes were compared with intended coordinates along the central trajectory at 4 levels: (1) 10 mm above the anatomical target, (2) in the target, (3) in the substantia nigra pars reticulata, and (4) at the depth of contact 1. Before the frame’s removal, Stereoplan coordinates of the contacts of the definitive electrode were compared with postoperative MRI coordinates. The mean of the differences was calculated in the x-, y-, and z-axis. Clinical results at 6 months were recorded.Results: The mean of the differences between Stereoplan coordinates and intended coordinates for the macroelectrodes was lower than 1 mm. A submillimeter difference was also found for the definitive contacts. At 6 months, the Unified Parkinson‘s Disease Rating Scale III score improved by 70.6% compared with the baseline score. Dyskinesia and motor fluctuations decreased by 85.7 and 87%, respectively (p < 0.0001). Conclusion: Stereoplan could be considered an accurate intraoperative radiological system which assures the correct position of the electrode in the anatomical target.

In vivo measurement of the frame-based application accuracy of the Neuromate neurosurgical robot

“…1 We used the Stereoplan system, a very accurate measuring system used routinely for many years to intraoperatively check the location of DBS electrodes. 3,[5][6][7]12 The Stereoplan requires orthogonal radiographs only, but requires the use of the Fischer stereotactic frame and fiducials. For this reason we were able to measure the in vivo accuracy of the Neuromate robot in frame-based conditions only, although its frameless utilization also has numerous advantages.…”

“…1B) and software (Stereoplan version 2.0, Leibinger), a system used for years in routine DBS procedures. 3,[5][6][7]12 …”

Multimodal Localization of Electrodes in Deep Brain Stimulation: Comparison of Stereotactic CT and MRI with Teleradiography

“…In contrast to former studies, which used anatomical landmarks for image fusion of Xray and MRI [12][13][14] , stereotactic localizers were used for image fusion. This generally results in a high accuracy for the coregistration [15] , and the coregistration cannot be hampered by brain shift.…”

“…Imaging Protocol X-ray is widely seen as gold standard for electrode localizing [5,12,13] , and thus we used it as the gold standard as well. X-ray depicts metallic objects with a high contrast, therefore making it easy to define the actual position of an electrode.…”

“…X-ray depicts metallic objects with a high contrast, therefore making it easy to define the actual position of an electrode. Furthermore, using a film for X-ray detection leads to negligible geometric distortions compared to a combination of a C-arm with an image intensifier which has inherent geometric distortions, a system used in other studies on stereotactical guidance accuracy [12,13] .…”