Intraoperative Computed Tomography for Deep Brain Stimulation Surgery: Technique and Accuracy Assessment
Intraoperative Computed Tomography for Deep Brain Stimulation Surgery: Technique and Accuracy Assessment
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DOI：
10.1227/neu.0b013e31820781bc
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发表时间：
2011-03-01
期刊：
影响因子：
4.8
通讯作者：
Starr, Philip A.
中科院分区：
文献类型：
--
作者：
Shahlaie, Kiarash;Larson, Paul S.;Starr, Philip A.
背景：脑深部刺激(DBS)的疗效高度依赖于电极放置的准确性。目的：描述术中CT(ICT)在手术闭合前确定电极位置的方法，并研究该技术的准确性。方法：15例患者在立体定向框架下接受清醒微电极引导的DBS手术。在整个手术过程中，便携式ICT扫描仪(美敦力O-ARM)被放置在患者的头部周围，并在将导线固定到头骨之前用于确认导线的位置。将图像与术前磁共振成像(MRI)进行计算融合，测量前、后连合线中点的导联尖端坐标。结果：ICT被整合到标准的基于框架的微电极引导的DBS手术中，手术时间或复杂性增加最小。所有病例均获得了技术上合适的2维和3维图像。描述了允许通畅成像的头部定位和固定技术。CT与术前MRI融合后的导联尖端测量结果与术后MRI的导联尖端测量结果无统计学差异。结论：ICT可以很容易地纳入标准的DBS手术，取代C臂透视的需要，并提供术中电极尖端位置相对于术前图像和手术计划的准确三维确认。ICT与术前MRI的融合可避免DBS手术中常规术后MRI的需要。描述了在植入DBS期间为有效使用ICT而必须掌握的技术细微差别。
BACKGROUND: The efficacy of deep brain stimulation (DBS) is highly dependent on the accuracy of lead placement.OBJECTIVE: To describe the use of intraoperative computed tomography (iCT) to confirm lead location before surgical closure and to study the accuracy of this technique.METHODS: Fifteen patients underwent awake microelectrode-guided DBS surgery in a stereotactic frame. A portable iCT scanner (Medtronic O-arm) was positioned around the patient's head throughout the procedure and was used to confirm lead location before fixation of the lead to the skull. Images were computationally fused with preoperative magnetic resonance imaging (MRI), and lead tip coordinates with respect to the midpoint of the anterior commissure-posterior commissure line were measured. Tip coordinates were compared with those obtained from postoperative MRI.RESULTS: iCT was integrated into standard frame-based microelectrode-guided DBS surgery with a minimal increase in surgical time or complexity. Technically adequate 2-dimensional and 3-dimensional images were obtained in all cases. Head positioning and fixation techniques that allow unobstructed imaging are described. Lead tip measurements on iCT fused with preoperative MRI were statistically indistinguishable from those obtained with postoperative MRI.CONCLUSION: iCT can be easily incorporated into standard DBS surgery, replaces the need for C-arm fluoroscopy, and provides accurate intraoperative 3-dimensional confirmation of electrode tip locations relative to preoperative images and surgical plans. iCT fused to preoperative MRI may obviate the need for routine postoperative MRI in DBS surgery. Technical nuances that must be mastered for the efficient use of iCT during DBS implantation are described.