O-Arm Stereotactic Imaging in Deep Brain Stimulation Surgery Workflow: A Utility and Cost-Effectiveness Analysis

Abstract

<b><i>Introduction:</i></b> Deep brain stimulation (DBS) surgery is an established treatment for movement disorders. Advances in neuroimaging techniques have resulted in improved targeting accuracy that may improve clinical outcomes. This study aimed to evaluate the safety and feasibility of using the Medtronic O-arm device for the acquisition of intraoperative stereotactic imaging, targeting, and localization of DBS electrodes compared with standard stereotactic MRI or computed tomography (CT). <b><i>Methods:</i></b> Patients were recruited prospectively into the study. Routine frame-based stereotactic DBS surgery was performed. Intraoperative imaging was used to facilitate and verify the accurate placement of the intracranial electrodes. The acquisition of coordinates and verification of the position of the electrodes using the O-arm were evaluated and compared with conventional stereotactic MRI or CT. Additionally, a systematic review of the literature on the use of intraoperative imaging in DBS surgery was performed. <b><i>Results:</i></b> Eighty patients were included. The indications for DBS surgery were dystonia, Parkinson’s disease, essential tremor, and epilepsy. The globus pallidus internus was the most commonly targeted region (43.7%), followed by the subthalamic nucleus (35%). Stereotactic O-arm imaging reduced the overall surgical time by 68 min, reduced the length of time of acquisition of stereotactic images by 77%, reduced patient exposure to ionizing radiation by 24.2%, significantly reduced operating room (OR) costs per procedure by 31%, and increased the OR and neuroradiology suite availability. <b><i>Conclusions:</i></b> The use of the O-arm in DBS surgery workflow significantly reduced the duration of image acquisition, the exposure to ionizing radiation, and costs when compared with standard stereotactic MRI or CT, without reducing accuracy.

Feasibility and Accuracy of Robot-Assisted, Stereotactic Biopsy Using 3-Dimensional Intraoperative Imaging and Frameless Registration Tool

“…Regarding side effects for the patient, the average DLP was 159 mGy cm, which is 5 times lower than recommendations (850 mGy cm) of the French Radioprotection and Nuclear Safety Institute (Institut de radioprotection et de sûreté nucléaire) for a single cerebral CT scan acquisition and in the lower range compared with various European recommendations. 26,27 The DLP we report is lower than…”

“…26,27 The DLP we report is lower than in previous studies, ranging from 213 to 234 mGy cm, despite multiple acquisitions ensuring correct accuracy and localization (1 for robot calibration, 1 before drilling the skull, and another one before biopsy sampling). 28-30…”

Stereotactic Surgery of Parkinson’s Disease with Magnetic Resonance Imaging under Three‐Dimensional Mark Point Positioning Algorithm

“…Many factors in the surgical treatment play a corresponding role in the diagnosis and treatment of the disease, including the patients' condition, degree of cooperation, clinical experience, and general function status; the selection of the target during the surgery depends on clinical experience of the physicians [ 23 ]. Furlanetti et al [ 24 ] experimented with stereotaxic imaging to reduce the duration and cost of image acquisition without compromising accuracy. In this study, 37 patients (92.5%) in stereotactic surgery had an effect markedly effective.…”

Frameless x-ray-based lead re-implantation after partial hardware removal of deep brain stimulation system with preservation of intracerebral trajectories

“…Other methods to intraoperatively facilitate a three-dimensional depiction of the lead position are intraoperative CT or MRI [ 5 , 6 , 10 , 11 , 21 ]. Although these techniques have been shown to provide high accuracy of frameless stereotactic procedures, both modalities also require special equipment, which is a big investment for the most centers and hence not widely available [ 12 ]. This was also supported by the results of our survey, which revealed that intraoperative CT or MRI is not used in large-volume stereotactic centers in Germany.…”