Comparison of accuracy and precision between frame-based and frameless stereotactic navigation for deep brain stimulation electrode implantation
Comparison of accuracy and precision between frame-based and frameless stereotactic navigation for deep brain stimulation electrode implantation
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DOI：
10.1159/000103262
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发表时间：
2007-01-01
影响因子：
1.7
通讯作者：
Rehncrona, Stig
中科院分区：
文献类型：
--
作者：
Bjartmarz, Hjalmar;Rehncrona, Stig
对14例特发性震颤患者进行了无框架神经导航与传统的基于框架的立体定向植入脑深部刺激电极的准确性和精确度的比较。将DBS电极一次性植入双侧丘脑腹外侧区[腹中间核(VIM)]。一侧使用无框架神经导航，另一侧使用传统的基于框架的技术。靶向在MRI和CT成像的指导下进行。测量术中立体定向X线平片证实的最终电极位置和电极偏离计划靶点的位置。临床结果采用基本震颤评定量表进行评定。其中13名患者符合测量电极偏差的条件，其中10名患者可以进行临床随访。与基于框架的技术(x：0.5+/-0.5和y：0.4+/-0.4 mm)相比，无框架技术的电极在内侧(x：1.9+/-1.3 mm)和前后(y：0.9+/-0.8 mm)方向的电极偏离靶点较大，但在上下方向(Z)上相似。无框架技术的偏差向量为2.5+/-1.4 mm，基于框架的技术为1.2+/-0.6 mm。差异有统计学意义(P<；0.05~0.001)。无框架技术的离散度更大，表现为所有三个平面上的较大标准偏差。在临床随访中，无论植入技术如何，震颤减轻都是相似的。结果表明，传统的基于框架的立体定向法比无框架定向法具有更高的准确率/精确度。然而，这种差异相对较小，并不影响VIM中植入DBS电极治疗震颤的临床结果。版权所有(C)2007 S.Karger AG，巴塞尔
The accuracy and precision of frameless neuronavigation as compared to conventional frame-based stereotaxy for implantation of deep brain stimulation (DBS) electrodes were studied in 14 patients with essential tremor. DBS electrodes were implanted bilaterally in the ventrolateral thalamus [ventrointermediate nucleus ( VIM)] in one procedure. Frameless neuronavigation was used on one side and the conventional frame-based technique on the other. Targeting was guided by MRI and CT imaging. Intraoperative stereotactic plain X-ray verified final electrode positions and electrode deviations from the planned target were measured. Clinical outcome was evaluated with the Essential Tremor Rating Scale. Thirteen of the patients were eligible for measuring electrode deviations and 10 of them were available for a clinical follow-up. Electrode deviations from target were larger using the frameless technique in the mediallateral (x: 1.9 +/- 1.3 mm) and anterior- posterior (y: 0.9 +/- 0.8 mm) directions as compared to the frame-based technique (x: 0.5 +/- 0.5 and y: 0.4 +/- 0.4 mm) but similar in the superior- inferior direction (z). The vector of deviation was 2.5 +/- 1.4 mm with the frameless technique and 1.2 +/- 0.6 with the frame-based technique. The differences were statistically significant (p < 0.05-0.001). The dispersion was larger with the frameless technique as represented by the larger standard deviations in all three planes. At clinical follow-ups, tremor reduction was similar irrespective of the implantation technique. It is concluded that conventional frame-based stereotaxy has higher accuracy/precision for hitting a small brain target than the frameless technique. However, the difference is relatively small and does not influence the clinical result of DBS electrode implantations in the VIM when treating tremor. Copyright (c) 2007 S. Karger AG, Basel