Frameless stereotaxy in subthalamic deep brain stimulation: 3-year clinical outcome

Abstract

Background In most centers, the surgery of deep brain stimulation (DBS) is performed using a stereotactic frame. Compared with frame-based technique, frameless stereotaxy reduces the duration of surgical procedure and patient’s discomfort, with lead placing accuracy equivalent after the learning curve. Although several studies have investigated the targeting accuracy of this technique, only a few studies reported clinical outcomes, with data of short-term follow-up. Objective To assess clinical efficacy and safety of frameless bilateral subthalamic nucleus (STN) DBS in Parkinson’s disease (PD) patients at 1- and 3-year follow-up. Methods Consecutive PD patients who underwent bilateral STN-DBS with a manual adjustable frameless system were included in the study. The data were collected retrospectively. Results Eighteen PD patients underwent bilateral STN-DBS implant and were included in the study. All patients completed 1-year observation and ten of them completed 3-year observation. At 1-year follow-up, motor efficacy of STN stimulation in off-med condition was of 30.1% ( P = 0.003) and at 3-year follow-up was of 36.3%, compared with off-stim condition at 3-year follow-up ( P = 0.005). Dopaminergic drugs were significantly reduced by 31.2% 1 year after the intervention ( P = 0.003) and 31.7% 3 years after the intervention ( P = 0.04). No serious adverse events occurred during surgery. Conclusions Frameless stereotaxy is an effective and safe technique for DBS surgery at 1- and 3-year follow-up, with great advantages for patients’ discomfort during surgery.

Long-term safety and efficacy of frameless subthalamic deep brain stimulation in Parkinson’s disease

“…For each patient, contrast-enhanced volumetric T1-weighted 1.5 Tesla magnetic resonance imaging (MRI) of the whole head and T2-weighted images through the STN were obtained before the procedure. All patients underwent frameless surgery by using the NexFrame system (Medtronic®, Minneapolis, MN), with bilateral implantation of the DBS leads in the subthalamic nucleus, as detailed in a previous study [ 16 ]. The sensorimotor region of the STN was identified with single-track multipass microelectrode recording using 1 megaOhm platinum-iridium microelectrodes (FHC Corp, Bowdoinham, Maine).…”

“…Although several groups have investigated the topographical accuracy of the frameless stereotaxy [ 10 ], a few studies reported its clinical outcomes, mostly in the short term [ 13 – 15 ], with only one exploring the long-term in this population. In fact, our group reported clinical outcomes of patients undergone frameless STN-DBS for PD up to 3 years from implantation [ 16 ].…”

Evolution of Deep Brain Stimulation Techniques for Complication Mitigation

“…Microelectrode recording [45][46][47][48][49] Avoidance of sulci 50 Transventricular approaches 45,50,54 Hypertension 50,55,56 Blood thinners [57][58][59][60] Postoperative confusion Risk factor identification [61][62][63][64][65][66][67][68][69] OR time reduction 84,[122][123][124] Lead inaccuracies Cerebrospinal fluid loss [71][72][73][74] Skull-mounted frames [83][84][85][86][87][88][89][90][91][92][93][94] Robotics [95][96][97][98][99]…”

“…79,80,82 Furthermore, the development of skull-mounted approaches has led to even further reductions in accuracy errors. [83][84][85][86][87][88][89] Konrad et al 90 demonstrated that the use of STarFix (FHC) resulted in a mean targeting error of 1.24 mm when brain shift was minimal and a reduction of 2 hours in operating time. A mean accuracy of 0.6 ± 0.3 mm and comparable outcomes were seen in 26 patients implanted using the SmartFrame system (ClearPoint Neuro).…”

Deep Brain Stimulation for the Management of Refractory Neurological Disorders: A Comprehensive Review

“…After securing the frame, stereotactic imaging is performed to aid in planning the electrode's target and trajectory. Various software packages are available for this purpose, and they can employ coordinate frame-based, frameless, or robotic stereotaxic procedures [13].…”