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. 2020 Sep 27;10(10):683.
doi: 10.3390/brainsci10100683.

O-Arm Navigated Frameless and Fiducial-Less Deep Brain Stimulation

David Krahulík  1 , Martin Nevrlý  2 , Pavel Otruba  2 , Jan Bardoň  2 , Lumír Hrabálek  1 , Daniel Pohlodek  1 , Petr Kaňovský  2 , Jan Valošek  1   2
Affiliations

O-Arm Navigated Frameless and Fiducial-Less Deep Brain Stimulation

David Krahulík et al. Brain Sci. .

Abstract

Object: Deep brain stimulation (DBS) is a very useful procedure for the treatment of idiopathic Parkinson's disease (PD), essential tremor, and dystonia. The authors evaluated the accuracy of the new method used in their center for the placing of DBS electrodes. Electrodes are placed using the intraoperative O-arm™ (Medtronic)-controlled frameless and fiducial-less system, Nexframe™ (Medtronic). Accuracy was evaluated prospectively in eleven consecutive PD patients (22 electrodes).

Methods: Eleven adult patients with PD were implanted using the Nexframe system without fiducials and with the intraoperative O-arm (Medtronic) system and StealthStation™ S8 navigation (Medtronic). The implantation of DBS leads was performed using multiple-cell microelectrode recording, and intraoperative test stimulation to determine thresholds for stimulation-induced adverse effects. The accuracy was checked in three different steps: (1) using the intraoperative O-arm image and its fusion with preoperative planning, (2) using multiple-cell microelectrode recording and counting the number of microelectrodes with the signal of the subthalamic nucleus (STN) and finally, (3) total error was calculated according to a postoperative CT control image fused to preoperative planning.

Results: The total error of the procedure was 1.79 mm; the radial error and the vector error were 171 mm and 163 mm.

Conclusions: Implantation of DBS electrodes using an O-arm navigated frameless and fiducial-less system is a very useful and technically feasible procedure with excellent patient toleration with experienced Nexframe users. The accuracy of the method was confirmed at all three steps, and it is comparable to other published results.

Keywords: Nexframe; O-arm; Parkinson’s disease; deep brain stimulation.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Image from neuronavigational system showing perfect correlation of the actual electrode position and the preoperative planned trajectory.
Figure 2
Figure 2
Image from neuronavigational system showing final position of the electrode in the planed target point within the subthalamic nucleus (STN).
Figure 3
Figure 3
Boxplots showing the radial and vector errors.
See this image and copyright information in PMC

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