Improved accuracy using a modified registration method of ROSA in deep brain stimulation surgery

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>The aim of this study was to determine whether a modified registration method could reduce registration error and postoperative electrode vector error and to analyze the method’s clinical significance in deep brain stimulation (DBS) surgery.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>The first part of the study involved a skull model, in which three registration methods were tested using the ROSA (robotic stereotactic assistance) system. In the second part, four registration methods were clinically tested in patients undergoing DBS surgery using the ROSA system. Thirty-three patients (65 sides, group I) underwent the conventional registration method 2E, and registration errors were recorded. Thirty-eight patients (75 sides, group II) underwent four types of modified registration methods including 2A, 2B, 2C, and 2D. Registration and electrode vector errors, intraoperative electrophysiological signal length (IESL), and DBS power-on voltage were recorded. The primary measure of efficacy was the change in the Unified Parkinson’s Disease Rating Scale (UPDRS) and UPDRS Part III scores from baseline to 10 weeks after surgery.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>In the skull model, the registration error (mean ± SD) was 0.56 ± 0.11 mm for method 1A, 0.35 ± 0.11 mm for method 1B (vs. 1A, p &lt; 0.001), and 0.90 ± 0.15 mm for method 1C (vs. 1A, p &lt; 0.001). In the clinical study, method 2C was selected for DBS surgery in group II since it had the smallest registration error among the four methods tested. The registration error was 0.62 ± 0.22 mm (mean ± SD) for group I and 0.27 ± 0.07 mm for group II (p &lt; 0.001). Postoperative electrode vector error was 0.97 ± 0.31 mm for group I and 0.65 ± 0.23 mm for group II (p &lt; 0.001). There was a positive correlation between registration error and electrode vector error in both groups (group I: r = 0.69, p &lt; 0.001; group II: r = 0.71, p &lt; 0.001). The mean IESL was 5.0 ± 0.9 mm in group I and 5.8 ± 0.7 mm in group II (p &lt; 0.001). The mean DBS power-on voltage was 1.63 ± 0.44 V in group I and 1.48 ± 0.38 V in group II (p = 0.027). In the UPDRS score, group I showed 50% ± 16% improvement and group II showed 52% ± 18% improvement (p = 0.724); there was no statistically significant difference in improvement on the UPDRS.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>In DBS surgery assisted by the ROSA system, registration error and electrode vector error showed a positive correlation. The modified registration method could reduce the registration error and electrode vector error, but the long-term effects need to be further observed and evaluated.</jats:p></jats:sec>

Targeted Deep Brain Stimulation of the Motor Thalamus Facilitates Voluntary Motor Control After Cortico-spinal Tract Lesions

“…These errors were consistent with our previous report 36 (Extended Data Fig. 1) and similar to the errors observed in human DBS implantations (0.27 ± 0.07 mm) 37 . At the end of the experimental procedures, we created a small thermocoagulation lesion at the electrode tip to allow post-mortem visualization of the implant location.…”

Increased variance in second electrode accuracy during deep brain stimulation and its relationship to pneumocephalus, brain shift, and clinical outcomes: a retrospective cohort study

“…Revision surgery has been documented as occurring in up to 15% [39,[43][44][45][46][47][48] with consequent effects on healthcare services, finances, and risk of surgical complications. Myriad technologies have been proposed with the aim of improving accuracy, including the use of robotics [49][50][51][52]. In our data we identified three participants each with a single electrode location outside of the target nucleus by greater than 2mm.…”

Primary Brainstem Hemorrhage: A Review of Prognostic Factors and Surgical Management

“…With the application of various advanced stereotactic techniques, such as the ROSA (Robotized Stereotactic Assistant) device, stereoscopic virtual reality system, and augmented reality interactive neuronavigation, the surgical procedure would be increasingly safe and precise (91)(92)(93).…”