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Mayer R, Desai K, Aguiar RSDT, McClure JJ, Kato N, Kalman C, Pilitsis JG. Evolution of Deep Brain Stimulation Techniques for Complication Mitigation. Oper Neurosurg (Hagerstown) 2024:01787389-990000000-01044. [PMID: 38315020 DOI: 10.1227/ons.0000000000001071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 12/07/2023] [Indexed: 02/07/2024] Open
Abstract
Complication mitigation in deep brain stimulation has been a topic matter of much discussion in the literature. In this article, we examine how neurosurgeons as individuals and as a field generated and adapted techniques to prevent infection, lead fracture/lead migration, and suboptimal outcomes in both the acute period and longitudinally. The authors performed a MEDLINE search inclusive of articles from 1987 to June 2023 including human studies written in English. Using the Rayyan platform, two reviewers (J.P. and R.M.) performed a title screen. Of the 776 articles, 252 were selected by title screen and 172 from abstract review for full-text evaluation. Ultimately, 124 publications were evaluated. We describe the initial complications and inefficiencies at the advent of deep brain stimulation and detail changes instituted by surgeons that reduced them. Furthermore, we discuss the trend in both undesired short-term and long-term outcomes with emphasis on how surgeons recognized and modified their practice to provide safer and better procedures. This scoping review adds to the literature as a guide to both new neurosurgeons and seasoned neurosurgeons alike to understand better what innovations have been trialed over time as we embark on novel targets and neuromodulatory technologies.
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Affiliation(s)
- Ryan Mayer
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida, USA
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Taleb A, Guigou C, Leclerc S, Lalande A, Bozorg Grayeli A. Image-to-Patient Registration in Computer-Assisted Surgery of Head and Neck: State-of-the-Art, Perspectives, and Challenges. J Clin Med 2023; 12:5398. [PMID: 37629441 PMCID: PMC10455300 DOI: 10.3390/jcm12165398] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/08/2023] [Accepted: 08/14/2023] [Indexed: 08/27/2023] Open
Abstract
Today, image-guided systems play a significant role in improving the outcome of diagnostic and therapeutic interventions. They provide crucial anatomical information during the procedure to decrease the size and the extent of the approach, to reduce intraoperative complications, and to increase accuracy, repeatability, and safety. Image-to-patient registration is the first step in image-guided procedures. It establishes a correspondence between the patient's preoperative imaging and the intraoperative data. When it comes to the head-and-neck region, the presence of many sensitive structures such as the central nervous system or the neurosensory organs requires a millimetric precision. This review allows evaluating the characteristics and the performances of different registration methods in the head-and-neck region used in the operation room from the perspectives of accuracy, invasiveness, and processing times. Our work led to the conclusion that invasive marker-based methods are still considered as the gold standard of image-to-patient registration. The surface-based methods are recommended for faster procedures and applied on the surface tissues especially around the eyes. In the near future, computer vision technology is expected to enhance these systems by reducing human errors and cognitive load in the operating room.
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Affiliation(s)
- Ali Taleb
- Team IFTIM, Institute of Molecular Chemistry of University of Burgundy (ICMUB UMR CNRS 6302), Univ. Bourgogne Franche-Comté, 21000 Dijon, France; (C.G.); (S.L.); (A.L.); (A.B.G.)
| | - Caroline Guigou
- Team IFTIM, Institute of Molecular Chemistry of University of Burgundy (ICMUB UMR CNRS 6302), Univ. Bourgogne Franche-Comté, 21000 Dijon, France; (C.G.); (S.L.); (A.L.); (A.B.G.)
- Otolaryngology Department, University Hospital of Dijon, 21000 Dijon, France
| | - Sarah Leclerc
- Team IFTIM, Institute of Molecular Chemistry of University of Burgundy (ICMUB UMR CNRS 6302), Univ. Bourgogne Franche-Comté, 21000 Dijon, France; (C.G.); (S.L.); (A.L.); (A.B.G.)
| | - Alain Lalande
- Team IFTIM, Institute of Molecular Chemistry of University of Burgundy (ICMUB UMR CNRS 6302), Univ. Bourgogne Franche-Comté, 21000 Dijon, France; (C.G.); (S.L.); (A.L.); (A.B.G.)
- Medical Imaging Department, University Hospital of Dijon, 21000 Dijon, France
| | - Alexis Bozorg Grayeli
- Team IFTIM, Institute of Molecular Chemistry of University of Burgundy (ICMUB UMR CNRS 6302), Univ. Bourgogne Franche-Comté, 21000 Dijon, France; (C.G.); (S.L.); (A.L.); (A.B.G.)
- Otolaryngology Department, University Hospital of Dijon, 21000 Dijon, France
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Deboeuf L, Moiraghi A, Debacker C, Peeters SM, Simboli GA, Roux A, Dezamis E, Oppenheim C, Chretien F, Pallud J, Zanello M. Feasibility and Accuracy of Robot-Assisted, Stereotactic Biopsy Using 3-Dimensional Intraoperative Imaging and Frameless Registration Tool. Neurosurgery 2023; 92:803-811. [PMID: 36700740 DOI: 10.1227/neu.0000000000002294] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 09/27/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Robot-assisted stereotactic biopsy is evolving: 3-dimensional intraoperative imaging tools and new frameless registration systems are spreading. OBJECTIVE To investigate the accuracy and effectiveness of a new stereotactic biopsy procedure. METHODS Observational, retrospective analysis of consecutive robot-assisted stereotactic biopsies using the Neurolocate (Renishaw) frameless registration system and intraoperative O-Arm (Medtronic) performed at a single institution in adults (2019-2021) and comparison with a historical series from the same institution (2006-2016) not using the Neurolocate nor the O-Arm. RESULTS In 100 patients (55% men), 6.2 ± 2.5 (1-14) biopsy samples were obtained at 1.7 ± 0.7 (1-3) biopsy sites. An histomolecular diagnosis was obtained in 96% of cases. The mean duration of the procedure was 59.0 ± 22.3 min. The mean distance between the planned and the actual target was 0.7 ± 0.7 mm. On systematic postoperative computed tomography scans, a hemorrhage ≥10 mm was observed in 8 cases (8%) while pneumocephalus was distant from the biopsy site in 76%. A Karnofsky Performance Status score decrease ≥20 points postoperatively was observed in 4%. The average dose length product was 159.7 ± 63.4 mGy cm. Compared with the historical neurosurgical procedure, this new procedure had similar diagnostic yield (96 vs 98.7%; P = .111) and rate of postoperative disability (4.0 vs 4.2%, P = .914) but was shorter (57.8 ± 22.9 vs 77.8 ± 20.9 min; P < .001) despite older patients. CONCLUSION Robot-assisted stereotactic biopsy using the Neurolocate frameless registration system and intraoperative O-Arm is a safe and effective neurosurgical procedure. The accuracy of this robot-assisted surgery supports its effectiveness for daily use in stereotactic neurosurgery.
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Affiliation(s)
- Louise Deboeuf
- Department of Neurosurgery, GHU Paris - Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Paris, France
- Université de Paris, Paris , France
| | - Alessandro Moiraghi
- Department of Neurosurgery, GHU Paris - Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Paris, France
- Université de Paris, Paris , France
- INSERM UMR 1266, IMA-BRAIN, Institute of Psychiatry and Neurosciences of Paris, Paris, France
| | - Clément Debacker
- Université de Paris, Paris , France
- INSERM UMR 1266, IMA-BRAIN, Institute of Psychiatry and Neurosciences of Paris, Paris, France
| | - Sophie M Peeters
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, California, USA
| | - Giorgia Antonia Simboli
- Department of Neurosurgery, GHU Paris - Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Paris, France
- Université de Paris, Paris , France
| | - Alexandre Roux
- Department of Neurosurgery, GHU Paris - Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Paris, France
- Université de Paris, Paris , France
- INSERM UMR 1266, IMA-BRAIN, Institute of Psychiatry and Neurosciences of Paris, Paris, France
| | - Edouard Dezamis
- Department of Neurosurgery, GHU Paris - Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Paris, France
- Université de Paris, Paris , France
| | - Catherine Oppenheim
- Université de Paris, Paris , France
- INSERM UMR 1266, IMA-BRAIN, Institute of Psychiatry and Neurosciences of Paris, Paris, France
- Department of Neuroradiology, GHU Paris - Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Paris, France
| | - Fabrice Chretien
- Université de Paris, Paris , France
- INSERM UMR 1266, IMA-BRAIN, Institute of Psychiatry and Neurosciences of Paris, Paris, France
- Department of Neuropathology, GHU Paris - Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Paris, France
| | - Johan Pallud
- Department of Neurosurgery, GHU Paris - Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Paris, France
- Université de Paris, Paris , France
- INSERM UMR 1266, IMA-BRAIN, Institute of Psychiatry and Neurosciences of Paris, Paris, France
| | - Marc Zanello
- Department of Neurosurgery, GHU Paris - Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Paris, France
- Université de Paris, Paris , France
- INSERM UMR 1266, IMA-BRAIN, Institute of Psychiatry and Neurosciences of Paris, Paris, France
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Weise LM, McCormick I, Restrepo C, Hill R, Greene R, Hong M, Potvin C, Flynn P, Morris S, Quick-Weller J. Motor evoked potentials versus Macrostimulation in predicting the postoperative motor threshold in STN Deep brain stimulation. Clin Neurol Neurosurg 2022; 219:107332. [PMID: 35738118 DOI: 10.1016/j.clineuro.2022.107332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 06/01/2022] [Accepted: 06/04/2022] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Accuracy is crucial in Deep Brain Stimulation (DBS). Electrophysiological and image-based techniques are used to avoid suboptimal positioning. Macrostimulation is the gold standard to delineate the therapeutic window intraoperatively. Despite this, electrode revision rates due to malpositioning are as high as 17%. The goal was to compare motor evoked potentials (MEPs) with the gold standard of Macrostimulation. We assessed accuracy and precision as well as the correlation in predicting motor side effects at the initial mapping 4 weeks postoperatively. METHODS In this prospective study intraoperative MEPs from 94 contacts in 16 patients undergoing STN DBS under local anesthesia were correlated to the postoperative threshold for stimulation-induced motor side effects and compared to intraoperative Macrostimulation. Analysis of accuracy, precision and correlation (Pearson) was performed. RESULTS MEPs of the upper extremity had a mean percentage error of 25% (SD 38.8%) and correlated significantly with the motor threshold at postoperative mapping (R=0.235). Macrostimulation was less accurate and precise with a mean percentage error of - 68% (SD 78.8%) but had a higher correlation (R=0.388). MEPs rarely (3%) overestimated the threshold by maximally 1 mA. In contrast, Macrostimulation overestimated the threshold by over 1 mA in 69% leading to a false sense of security. CONCLUSION MEPs are feasible in an awake setting during Deep Brain Stimulation in the STN for PD patients. MEPs of the upper extremity are more accurate and precise predicting the motor threshold and avoid a false sense of security in comparison to the gold standard of Macrostimulation.
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Affiliation(s)
- Lutz Martin Weise
- Dalhousie University, Department of Surgery, Division of Neurosurgery, Halifax, Canada.
| | - Ian McCormick
- Dalhousie University, Department of Psychology and Neuroscience, Halifax, Canada
| | - Carlos Restrepo
- Dalhousie University, Department of Surgery, Division of Neurosurgery, Halifax, Canada
| | - Ron Hill
- Dalhousie University, Department of Surgery, Division of Neurosurgery, Halifax, Canada
| | - Ryan Greene
- Dalhousie University, Department of Surgery, Division of Neurosurgery, Halifax, Canada
| | - Murray Hong
- Dalhousie University, Department of Surgery, Division of Neurosurgery, Halifax, Canada
| | - Christine Potvin
- Dalhousie University, Department of Surgery, Division of Neurosurgery, Halifax, Canada
| | - Peggy Flynn
- Dalhousie University, Department of Surgery, Division of Neurosurgery, Halifax, Canada
| | - Susan Morris
- Dalhousie University, Department of Surgery, Division of Neurosurgery, Halifax, Canada
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Validation of 3D fluoroscopy for image-guidance registration in depth electrode implantation for medically refractory epilepsy. Acta Neurochir (Wien) 2021; 163:1347-1354. [PMID: 33443679 DOI: 10.1007/s00701-021-04706-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 01/04/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Frame registration is a critical step to ensure accurate electrode placement in stereotactic procedures such as stereoelectroencephalography (SEEG) and is routinely done by merging a computed tomography (CT) scan with the preoperative magnetic resonance (MR) examination. Three-dimensional fluoroscopy (XT) has emerged as a method for intraoperative electrode verification following electrode implantation and more recently has been proposed as a registration method with several advantages. METHODS We compared the accuracy of SEEG electrode placement by frame registration with CT and XT imaging by analyzing the Euclidean distance between planned and post-implantation trajectories of the SEEG electrodes to calculate the error in both the entry (EP) and target (TP) points. Other variables included radiation dose, efficiency, and complications. RESULTS Twenty-seven patients (13 CT and 14 XT) underwent placement of SEEG electrodes (319 in total). The mean EP and TP errors for the CT group were 2.3 mm and 3.3 mm, respectively, and 1.9 mm and 2.9 mm for the XT group, with no statistical difference (p = 0.75 and p = 0.246). The time to first electrode placement was similar (XT, 82 ± 10 min; CT, 84 ± 22 min; p = 0.858) and the average radiation exposure with XT (234 ± 55 mGy*cm) was significantly lower than CT (1245 ± 123 mGy*cm) (p < 0.0001). Four complications were documented with equal incidence in both groups. CONCLUSIONS The use of XT as a method for registration resulted in similar implantation accuracy compared with CT. Advantages of XT are the substantial reduction in radiation dose and the elimination of the need to transfer the patient out of the room which may have an impact on patient safety and OR efficiency.
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