Frameless Stereotaxis for Subthalamic Nucleus Deep Brain Stimulation: An Innovative Method for the Direct Visualization of Electrode Implantation by Intraoperative X-ray Control

Abstract

The recent introduction of frameless devices has enabled stereotactic neurosurgery to reach a level of accuracy that is comparable to traditional frame-based methodologies. Among frameless devices, the Nexframe appears to be very useful in implanting electrodes into the subthalamic nucleus or other structures for deep brain stimulation in Parkinson’s disease. However, frameless devices, including the Nexframe, limit the possibility of intraoperative visual control of the placement of electrodes in the brain. Utilizing intraoperative O-arm Computed tomography (CT) scan or high-field Magnetic Resonance Imaging (MRI) could overcome this limitation, but their high cost restricts their use. Thus, in this paper we propose an innovation in Nexframe surgical planning that allows the intraoperative use of a C-arm X-ray apparatus to establish: (1) the progression of the electrode guide tube and the electrode in the brain; (2) the accuracy of the electrode trajectory; and (3) the correct attainment of the target. The proposed frameless technique using the Nexframe has been developed and successfully applied in our practice. It was shown to be helpful in overcoming the major issues that are usually encountered when electrodes are placed in the brain with frameless neurosurgery and reduced the risk of having to re-operate on patients to reposition the electrodes.

Intensity-dependent gamma electrical stimulation regulates microglial activation, reduces beta-amyloid load, and facilitates memory in a mouse model of Alzheimer’s disease

“…Precision electrical stimulation of brain structures can be achieved through stereotactic implantation of fine electrodes, which have been well-developed for humans and experimental animals [34,35]. Stereotaxic brain electrode implantation has been successfully used for various diseases [35][36][37][38][39][40][41][42][43]. However, complications do happen despite significantly expensive and surgically-demanding procedures [44,45].…”

Intensity-Dependent Gamma Electrical Stimulation Regulates Microglial Activation, Reduces Beta-Amyloid Load, and Facilitates Memory in a Mouse Model of Alzheimer's Disease

“…Precision electrical stimulation of brain structures can be achieved through stereostatic implantation of ne electrodes, which have been well developed for human and experimental animals [31,32]. Stereotaxic brain electrode implantation has been successfully used for various diseases [32][33][34][35][36][37][38][39][40]. However, complications do happen despite signi cantly expensive and surgically demanding procedures [41,42].…”

Abordaje seguro al núcleo subtalámico. Impacto del ángulo parasagital mayor de 20 grados.

“…En los pacientes con diagnóstico de EP, a los que se les realizará tratamiento quirúrgico de subtalamotomía dorsolateral o ECP del NST, es importante planificar la trayectoria de los electrodos evitando el sistema ventricular, los surcos cerebrales y los vasos sanguíneos, 15,18,25,31,37 disminuyendo de esta manera las posibles complicaciones derivadas de atravesar estas estructuras, por lo que en aquellos pacientes que presentan dilatación ventricular y atrofia cerebral, es necesario realizar el abordaje del NST con un ángulo parasagital mayor de 15 grados para evitar dichas estructuras. 33 En un estudio publicado por L. Álvarez y colaboradores 17 y otro de López-Flores y colaboradores, 18 necesitaron realizar de 4 a 14 y de 5 a 15 trayectos de registro respectivamente para la identificación del NST con una media en ambos estudios de 7,2 trayectos; en otra publicación del mismo grupo 19 la media de los trayectos de registro fue de 5,6 con un rango de 3 a 14.…”