Frameless stereotaxy using bone fiducial markers for deep brain stimulation
Frameless stereotaxy using bone fiducial markers for deep brain stimulation
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DOI：
10.3171/jns.2005.103.3.0404
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发表时间：
2005-09-01
影响因子：
4.1
通讯作者：
Henderson, JM
中科院分区：
文献类型：
--
作者：
Holloway, KL;Gaede, SE;Henderson, JM
Object.功能性神经外科干预，如脑深部电刺激（DBS），传统上是在立体定向框架的帮助下进行的。尽管无框架技术被认为不太准确，但最近一项修改的无框架方法的体模研究的数据表明，实验室准确度超过了使用普通框架系统获得的准确度。本研究旨在评估无框架系统在常规临床使用中的准确性。使用颅骨安装的轨迹引导器和图像引导工作站在38例患者中植入脑深部刺激电极导线。使用骨基准标记完成配准。在术后计算机断层扫描上测量最终电极导线位置，并与计划的电极导线位置进行比较。最近的一项研究报告了Leksell框架在临床情况下的准确性;这些原始数据用作比较数据集。X平面中预期和实际电极导线位置之间的差异在基于框架的手术中为1.4 mm，在无框架手术中为1.6 mm。类似地，基于框架的系统中y平面的差异为1.6 mm，无框架系统中为1.3 mm。误差在z平面中最大，即在基于框架的方法中为1.7 min，在无框架系统中为2 mm。多因素方差分析表明两种方法的准确性无统计学显著差异。基于框架和无框架系统的准确度无统计学显著差异（p 0.22）。然而，请注意，无框架技术在患者舒适度、成像与手术分离以及减少手术时间方面具有优势。
Object. Functional neurosurgical interventions such as deep brain stimulation (DBS) are traditionally performed with the aid of a stereotactic frame. Although frameless techniques have been perceived as less accurate, data from a recent phantom study of a modified frameless approach demonstrated a laboratory accuracy exceeding that obtained using a common frame system. The present study was conducted to evaluate the accuracy of a frameless system in routine clinical use.Methods. Deep brain stimulation leads were implanted in 38 patients by using a skull-mounted trajectory guide and an image-guided workstation. Registration was accomplished with bone fiducial markers. Final lead positions were measured on postoperative computerized tomography scans and compared with the planned lead positions. The accuracy of the Leksell frame within the clinical situation has been reported on in a recent study; these raw data served as a comparison data set.The difference between expected and actual lead locations in the x plane was 1.4 mm in the frame-based procedure and 1.6 mm in the frameless procedure. Similarly, the difference in the y plane was 1.6 mm in the frame-based system and 1.3 mm in the frameless one. The error was greatest in the z plane, that is, 1.7 min in the frame-based method and 2 mm in the frameless system. Multivariate analysis of variance demonstrated no statistically significant difference in the accuracy of the two methods.Conclusions. The accuracy of the frame-based and frameless systems was not statistically significantly different (p 0.22). Note, however, that frameless techniques offer advantages in patient comfort, separation of imaging from surgery, and decreased operating time.