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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; 27:148-157. [PMID: 38315020 DOI: 10.1227/ons.0000000000001071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [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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2
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Manfield J, Martin S, Green AL, FitzGerald JJ. Evaluation of 3D C-Arm Fluoroscopy versus Diagnostic CT for Deep Brain Stimulation Stereotactic Registration and Post-Operative Lead Localization. Stereotact Funct Neurosurg 2024; 102:195-202. [PMID: 38537625 DOI: 10.1159/000536017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 12/09/2023] [Indexed: 06/05/2024]
Abstract
INTRODUCTION DBS efficacy depends on accuracy. CT-MRI fusion is established for both stereotactic registration and electrode placement verification. The desire to streamline DBS workflows, reduce operative time, and minimize patient transfers has increased interest in portable imaging modalities such as the Medtronic O-arm® and mobile CT. However, these remain expensive and bulky. 3D C-arm fluoroscopy (3DXT) units are a smaller and less costly alternative, albeit incompatible with traditional frame-based localization and without useful soft tissue resolution. We aimed to compare fusion of 3DXT and CT with pre-operative MRI to evaluate if 3DXT-MRI fusion alone is sufficient for accurate registration and reliable targeting verification. We further assess DBS targeting accuracy using a 3DXT workflow and compare radiation dosimetry between modalities. METHODS Patients underwent robot-assisted DBS implantation using a workflow incorporating 3DXT which we describe. Two intra-operative 3DXT spins were performed for registration and accuracy verification followed by conventional CT post-operatively. Post-operative 3DXT and CT images were independently fused to the same pre-operative MRI sequence and co-ordinates generated for comparison. Registration accuracy was compared to 15 consecutive controls who underwent CT-based registration. Radial targeting accuracy was calculated and radiation dosimetry recorded. RESULTS Data were obtained from 29 leads in 15 consecutive patients. 3DXT registration accuracy was significantly superior to CT with mean error 0.22 ± 0.03 mm (p < 0.0001). Mean Euclidean electrode tip position variation for CT to MRI versus 3DXT to MRI fusion was 0.62 ± 0.40 mm (range 0.0 mm-1.7 mm). In comparison, direct CT to 3DXT fusion showed electrode tip Euclidean variance of 0.23 ± 0.09 mm. Mean radial targeting accuracy assessed on 3DXT was 0.97 ± 0.54 mm versus 1.15 ± 0.55 mm on CT with differences insignificant (p = 0.30). Mean patient radiation doses were around 80% lower with 3DXT versus CT (p < 0.0001). DISCUSSION Mobile 3D C-arm fluoroscopy can be safely incorporated into DBS workflows for both registration and lead verification. For registration, the limited field of view requires the use of frameless transient fiducials and is highly accurate. For lead position verification based on MRI co-registration, we estimate there is around a 0.4 mm discrepancy between lead position seen on 3DXT versus CT when corrected for brain shift. This is similar to that described in O-arm® or mobile CT series. For units where logistical or financial considerations preclude the acquisition of a cone beam CT or mobile CT scanner, our data support portable 3D C-arm fluoroscopy as an acceptable alternative with significantly lower radiation exposure.
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Affiliation(s)
- James Manfield
- Oxford Functional Neurosurgery, John Radcliffe Hospital, Headley Way, Headington, Oxford, UK
| | - Sean Martin
- Oxford Functional Neurosurgery, John Radcliffe Hospital, Headley Way, Headington, Oxford, UK
| | - Alexander L Green
- Oxford Functional Neurosurgery, John Radcliffe Hospital, Headley Way, Headington, Oxford, UK
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - James J FitzGerald
- Oxford Functional Neurosurgery, John Radcliffe Hospital, Headley Way, Headington, Oxford, UK
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
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Genovese D, Bove F, Rigon L, Tufo T, Izzo A, Calabresi P, Bentivoglio AR, Piano C. Long-term safety and efficacy of frameless subthalamic deep brain stimulation in Parkinson's disease. Neurol Sci 2024; 45:565-572. [PMID: 37700176 PMCID: PMC10791817 DOI: 10.1007/s10072-023-07059-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 09/02/2023] [Indexed: 09/14/2023]
Abstract
BACKGROUND Bilateral deep brain stimulation (DBS) of the subthalamic nucleus (STN) is standard of care for Parkinson's disease (PD) patients and a correct lead placement is crucial to obtain good clinical outcomes. Evidence demonstrating the targeting accuracy of the frameless technique for DBS, along with the advantages for patients and clinicians, is solid, while data reporting long-term clinical outcomes for PD patients are still lacking. OBJECTIVES The study aims to assess the clinical safety and efficacy of frameless bilateral STN-DBS in PD patients at 5 years from surgery. METHODS Consecutive PD patients undergoing bilateral STN-DBS with a frameless system were included in this single-center retrospective study. Clinical features, including the Unified Parkinson's Disease Rating Scale (UPDRS) in its total motor score and axial sub-scores, and pharmacological regimen were assessed at baseline, 1 year, 3 years, and 5 years after surgery. The adverse events related to the procedure, stimulation, or the presence of the hardware were systematically collected. RESULTS Forty-one PD patients undergone bilateral STN-DBS implantation were included in the study and fifteen patients already completed the 5-year observation. No complications occurred during surgery and the perioperative phase, and no unexpected serious adverse event occurred during the entire follow-up period. At 5 years from surgery, there was a sustained motor efficacy of STN stimulation: STN-DBS significantly improved the off-stim UPDRS III score at 5 years by 37.6% (P < 0.001), while the dopaminergic medications remained significantly reduced compared to baseline (- 21.6% versus baseline LEDD; P = 0.036). CONCLUSIONS Our data support the use of the frameless system for STN-DBS in PD patients, as a safe and well-tolerated technique, with long-term clinical benefits and persistent motor efficacy at 5 years from the surgery.
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Affiliation(s)
- Danilo Genovese
- Neurology Unit, IRCCS Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Department of Neurology, The Marlene and Paolo Fresco Institute for Parkinson's and Movement Disorders, NYU Langone Health, New York, NY, USA
| | - Francesco Bove
- Neurology Unit, IRCCS Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
- Department of Neuroscience, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Leonardo Rigon
- Department of Neuroscience, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Tommaso Tufo
- Neurosurgery Unit, IRCCS Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Alessandro Izzo
- Neurosurgery Unit, IRCCS Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Paolo Calabresi
- Neurology Unit, IRCCS Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Department of Neuroscience, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Anna Rita Bentivoglio
- Neurology Unit, IRCCS Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Department of Neuroscience, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Carla Piano
- Neurology Unit, IRCCS Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Department of Neuroscience, Università Cattolica del Sacro Cuore, Rome, Italy
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Li C, Fan X, Aronson JP, Hong J, Khan T, Paulsen KD. Model-based image updating in deep brain stimulation with assimilation of deep brain sparse data. Med Phys 2023; 50:7904-7920. [PMID: 37418478 DOI: 10.1002/mp.16578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 04/06/2023] [Accepted: 05/01/2023] [Indexed: 07/09/2023] Open
Abstract
BACKGROUND Accuracy of electrode placement for deep brain stimulation (DBS) is critical to achieving desired surgical outcomes and impacts the efficacy of treating neurodegenerative diseases. Intraoperative brain shift degrades the accuracy of surgical navigation based on preoperative images. PURPOSE We extended a model-based image updating scheme to address intraoperative brain shift in DBS surgery and improved its accuracy in deep brain. METHODS We evaluated 10 patients, retrospectively, who underwent bilateral DBS surgery and classified them into groups of large and small deformation based on a 2 mm subsurface movement threshold and brain shift index of 5%. In each case, sparse brain deformation data were used to estimate whole brain displacements and deform preoperative CT (preCT) to generate updated CT (uCT). Accuracy of uCT was assessed using target registration errors (TREs) at the Anterior Commissure (AC), Posterior Commissure (PC), and four calcification points in the sub-ventricular area by comparing their locations in uCT with their ground truth counterparts in postoperative CT (postCT). RESULTS In the large deformation group, TREs were reduced from 2.5 mm in preCT to 1.2 mm in uCT (53% compensation); in the small deformation group, errors were reduced from 1.25 to 0.74 mm (41%). Average reduction of TREs at AC, PC and pineal gland were significant, statistically (p ⩽ 0.01). CONCLUSIONS With more rigorous validation of model results, this study confirms the feasibility of improving the accuracy of model-based image updating in compensating for intraoperative brain shift during DBS procedures by assimilating deep brain sparse data.
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Affiliation(s)
- Chen Li
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire, USA
| | - Xiaoyao Fan
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire, USA
| | - Joshua P Aronson
- Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, USA
- Section of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Jennifer Hong
- Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, USA
- Section of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Tahsin Khan
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire, USA
| | - Keith D Paulsen
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire, USA
- Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, USA
- Norris Cotton Cancer Center, Lebanon, New Hampshire, USA
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Srinvasan HL, Raslan A, Tambirajoo K, Selway R, Ashkan K, Hasegawa H. Neuromate ® robot-assisted ventricular catheter insertion. Br J Neurosurg 2023; 37:1689-1692. [PMID: 34187266 DOI: 10.1080/02688697.2021.1941762] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 06/07/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND IMPORTANCE Insertion of ventricular catheters into small ventricles may require image guidance. Several options exist, including ultrasound guidance, frameless, and frame-based stereotactic approaches. There is no literature on management options when conventional image guidance fails to cannulate the ventricle. The accuracy of the robotic arm is well established in functional and epilepsy surgery. We report the first case using the Neuromate® robot for the placement of a shunt ventricular catheter into the lateral ventricle after a failed attempt with a more commonly used frameless electromagnetic navigation system. CLINICAL PRESENTATION A 30-year-old man had twice previously undergone foramen magnum decompression for a Chiari 1 malformation. He subsequently developed a significant cervical syrinx with clinical deterioration and a decision was made to place a ventriculoperitoneal shunt. As the ventricles were small, frameless electromagnetic navigation was used but the ventricle could not be cannulated. The Neuromate® robot was subsequently used to place the ventricular catheter successfully. CONCLUSION Neuromate® robot-assisted ventricular catheter placement may be considered when difficulty is experienced with more commonly used image guidance techniques.
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Affiliation(s)
| | - Ahmed Raslan
- King's College Hospital, Neurosurgery, London, United Kingdom of Great Britain and Northern Ireland
| | - Kantharuby Tambirajoo
- King's College Hospital, Neurosurgery, London, United Kingdom of Great Britain and Northern Ireland
| | - Richard Selway
- King's College Hospital, Neurosurgery, London, United Kingdom of Great Britain and Northern Ireland
| | - Keyoumars Ashkan
- King's College Hospital, Neurosurgery, London, United Kingdom of Great Britain and Northern Ireland
| | - Harutomo Hasegawa
- King's College Hospital, Neurosurgery, London, United Kingdom of Great Britain and Northern Ireland
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Roldan P, Mosteiro A, Valldeoriola F, Rumià J. How I do it - asleep DBS placement for Parkinson's disease. Acta Neurochir (Wien) 2023; 165:2189-2195. [PMID: 37318635 PMCID: PMC10409652 DOI: 10.1007/s00701-023-05659-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 05/25/2023] [Indexed: 06/16/2023]
Abstract
BACKGROUND Traditionally, functional neurosurgery relied in stereotactic atlases and intraoperative micro-registration in awake patients for electrode placement in Parkinson's disease. Cumulative experience on target description, refinement of MRI, and advances in intraoperative imaging has enabled accurate preoperative planning and its implementation with the patient under general anaesthesia. METHODS Stepwise description, emphasising preoperative planning, and intraoperative imaging verification, for transition to asleep-DBS surgery. CONCLUSION Direct targeting relies on MRI anatomic landmarks and accounts for interpersonal variability. Indeed, the asleep procedure precludes patient distress. A particular complication to avoid is pneumocephalus; it can lead to brain-shift and potential deviation of electrode trajectory.
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Affiliation(s)
- Pedro Roldan
- Department of Neurosurgery, Hospital Clínic de Barcelona, Barcelona, Spain
- Department of Surgery, Faculty of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - Alejandra Mosteiro
- Department of Neurosurgery, Hospital Clínic de Barcelona, Barcelona, Spain.
- Department of Surgery, Faculty of Medicine, Universitat de Barcelona, Barcelona, Spain.
| | | | - Jordi Rumià
- Department of Neurosurgery, Hospital Clínic de Barcelona, Barcelona, Spain
- Department of Surgery, Faculty of Medicine, Universitat de Barcelona, Barcelona, Spain
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7
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Kaasalainen T, Männistö V, Mäkelä T, Suojanen J, Nuorala A, Heliövaara A, Leikola J. Postoperative computed tomography imaging of pediatric patients with craniosynostosis: radiation dose and image quality comparison between multi-slice computed tomography and O-arm cone-beam computed tomography. Pediatr Radiol 2023; 53:1704-1712. [PMID: 36967418 PMCID: PMC10359214 DOI: 10.1007/s00247-023-05644-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 03/08/2023] [Accepted: 03/09/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND When postoperative multi-slice computed tomography (MSCT) imaging of patients with craniosynostosis is used, it is usually performed a few days after surgery in a radiology department. This requires additional anesthesia for the patient. Recently, intraoperative mobile cone-beam CT (CBCT) devices have gained popularity for orthopedic and neurosurgical procedures, which allows postoperative CT imaging in the operating room. OBJECTIVE This single-center retrospective study compared radiation dose and image quality of postoperative imaging performed using conventional MSCT scanners and O-arm CBCT. MATERIALS AND METHODS A total of 104 pediatric syndromic and non-syndromic patients who were operated on because of single- or multiple-suture craniosynostosis were included in this study. The mean volumetric CT dose index (CTDIvol) and dose-length product (DLP) values of optimized craniosynostosis CT examinations (58 MSCT and 46 CBCT) were compared. Two surgeons evaluated the subjective image quality. RESULTS CBCT resulted in significantly lower CTDIvol (up to 14%) and DLP (up to 33%) compared to MSCT. Multi-slice CT image quality was considered superior to CBCT scans. However, all scans were considered to be of sufficient quality for diagnosis. CONCLUSION The O-arm device allowed for an immediate postoperative CBCT examination in the operating theater using the same anesthesia induction. Radiation exposure was lower in CBCT compared to MSCT scans, thus further encouraging the use of O-arms. Cone-beam CT imaging with an O-arm is a feasible method for postoperative craniosynostosis imaging, yielding less anesthesia to patients, lower health costs and the possibility to immediately evaluate results of the surgical operation.
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Affiliation(s)
- Touko Kaasalainen
- HUS Diagnostic Center, Radiology, University of Helsinki and Helsinki University Hospital, P.O. Box 340, 00290, Helsinki, Finland.
| | - Ville Männistö
- Department of Oral and Maxillofacial Surgery, Lahti Central Hospital, Päijät-Häme Joint Authority for Health and Wellbeing, Lahti, Finland
| | - Teemu Mäkelä
- HUS Diagnostic Center, Radiology, University of Helsinki and Helsinki University Hospital, P.O. Box 340, 00290, Helsinki, Finland
- Department of Physics, University of Helsinki, Helsinki, Finland
| | - Juho Suojanen
- Department of Oral and Maxillofacial Surgery, Lahti Central Hospital, Päijät-Häme Joint Authority for Health and Wellbeing, Lahti, Finland
- Cleft Palate and Craniofacial Center, Department of Plastic Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Antton Nuorala
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Arja Heliövaara
- Cleft Palate and Craniofacial Center, Department of Plastic Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Junnu Leikola
- Cleft Palate and Craniofacial Center, Department of Plastic Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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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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9
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Almairac F, Leplus A, Mondot L, Fontaine D. A New Noninvasive Frameless Registration System for Stereotactic Cranial Biopsy: A Technical Note. Oper Neurosurg (Hagerstown) 2023; 24:64-67. [PMID: 36227183 DOI: 10.1227/ons.0000000000000426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 07/16/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Although frame-based stereotactic biopsy is still considered the gold standard for brain biopsies, frameless robot-assisted stereotactic systems are now able to provide an equal level of safety and accuracy. However, both systems suffer from a lack of efficiency of the operative workflow. OBJECTIVE To describe the technique of a new frameless and noninvasive registration tool Neurolocate (Renishaw). This tool, combined with an intraoperative cone-beam computed tomography imaging system like O-ARM (Medtronic), might facilitate the achievement and workflow of robot-assisted stereotactic intracranial biopsies. METHODS Neurolocate is a 3-dimensional fiducial tool fixed directly on the Neuromate (Renishaw) robot arm. It consists of 5 radio-opaque spherical fiducials, whose geometry is constant. This tool made it possible to carry out the coregistration then the biopsy in the same operating time, following a five-step procedure described here. We retrospectively extracted selected preliminary results from our initial experience. RESULTS Over 1 year, 23 consecutive adult patients were biopsied with Neurolocate in our center. The mean overall operative time, from patient's installation to skin closure, was 97 minutes ± 27 (SD). The entire procedure took place in a single location unit (operating room), which facilitated workflow and surgical planning. No invasive gesture was performed outside of the operating time. CONCLUSION Neurolocate is a new frameless and noninvasive registration tool that could improve workflow and flexibility for operating room management and surgical planning. It may also increase the comfort of patients undergoing robot-assisted intracranial stereotactic biopsies. The accuracy and safety profile should be addressed in specific studies.
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Affiliation(s)
- Fabien Almairac
- Neurosurgery Department, Hôpital Pasteur 2, CHU de Nice, Nice, France.,UR2CA PIN, Université Côte d'Azur, Nice, France
| | - Aurélie Leplus
- Neurosurgery Department, Hôpital Pasteur 2, CHU de Nice, Nice, France.,UR2CA PIN, Université Côte d'Azur, Nice, France
| | - Lydiane Mondot
- Neuroradiology Department, Hôpital Pasteur 2, CHU de Nice, Nice, France.,UR2CA URRIS, Université Côte d'Azur, Nice, France
| | - Denys Fontaine
- Neurosurgery Department, Hôpital Pasteur 2, CHU de Nice, Nice, France.,UR2CA PIN, Université Côte d'Azur, Nice, France
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10
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Furlanetti L, Baig Mirza A, Raslan A, Velicu MA, Burford C, Akhbari M, German E, Saha R, Samuel M, Ashkan K. Factors Influencing Driving following DBS Surgery in Parkinson's Disease: A Single UK Centre Experience and Review of the Literature. J Clin Med 2022; 12:jcm12010166. [PMID: 36614967 PMCID: PMC9821168 DOI: 10.3390/jcm12010166] [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: 11/06/2022] [Revised: 12/21/2022] [Accepted: 12/22/2022] [Indexed: 12/28/2022] Open
Abstract
Parkinson's disease (PD) is a complex neurodegenerative disorder, leading to impairment of various neurological faculties, including motor, planning, cognitivity, and executive functions. Motor- and non-motor symptoms of the disease may intensify a patient's restrictions to performing usual tasks of daily living, including driving. Deep Brain Stimulation (DBS) associated with optimized clinical treatment has been shown to improve quality of life, motor, and non-motor symptoms in PD. In most countries, there are no specific guidelines concerning minimum safety requirements and the timing of return to driving following DBS, leaving to the medical staff of individual DBS centres the responsibility to draw recommendations individually regarding patients' ability to drive after surgery. The aim of this study was to evaluate factors that might influence the ability to drive following DBS in the management of PD. A total of 125 patients were included. Clinical, epidemiological, neuropsychological, and surgical factors were evaluated. The mean follow-up time was 129.9 months. DBS improved motor and non-motor symptoms of PD. However, in general, patients were 2.8-fold less likely to drive in the postoperative period than prior to surgery. Among the PD characteristics, patients with the akinetic subtype presented a higher risk to lose their driving licence postoperatively. Furthermore, the presence of an abnormal postoperative neuropsychological evaluation was also associated with driving restriction following surgery. Our data indicate that restriction to drive following surgery seems to be multifactorial rather than a direct consequence of DBS itself. Our study sheds light on the urgent need for a standardised multidisciplinary postoperative evaluation to assess patients' ability to drive following DBS.
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Affiliation(s)
- Luciano Furlanetti
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AB, UK
- King’s Health Partners Academic Health Sciences Centre, London SE1 9RT, UK
- Correspondence: ; Tel.: +44-(0)-203-299-3285
| | - Asfand Baig Mirza
- Department of Neurosurgery, King’s College Hospital NHS Foundation Trust, London SE5 9RS, UK
| | - Ahmed Raslan
- Department of Neurosurgery, King’s College Hospital NHS Foundation Trust, London SE5 9RS, UK
| | - Maria Alexandra Velicu
- Department of Neurosurgery, King’s College Hospital NHS Foundation Trust, London SE5 9RS, UK
| | - Charlotte Burford
- Department of Neurosurgery, King’s College Hospital NHS Foundation Trust, London SE5 9RS, UK
| | - Melika Akhbari
- Department of Neurosurgery, King’s College Hospital NHS Foundation Trust, London SE5 9RS, UK
| | - Elaine German
- Department of Neuropsychology, King’s College London, London SE5 8AB, UK
| | - Romi Saha
- Department of Neurology, King’s College Hospital NHS Foundation Trust, London SE5 9RS, UK
| | - Michael Samuel
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AB, UK
- King’s Health Partners Academic Health Sciences Centre, London SE1 9RT, UK
- Department of Neurology, King’s College Hospital NHS Foundation Trust, London SE5 9RS, UK
| | - Keyoumars Ashkan
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AB, UK
- Department of Neurosurgery, King’s College Hospital NHS Foundation Trust, London SE5 9RS, UK
- Department of Neurology, King’s College Hospital NHS Foundation Trust, London SE5 9RS, UK
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Stereotactic Surgery of Parkinson’s Disease with Magnetic Resonance Imaging under Three-Dimensional Mark Point Positioning Algorithm. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:9383982. [PMID: 35833058 PMCID: PMC9251154 DOI: 10.1155/2022/9383982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/20/2022] [Accepted: 05/26/2022] [Indexed: 11/17/2022]
Abstract
This research aimed to study the application of magnetic resonance imaging (MRI) under three-dimensional mark point positioning algorithm in stereotactic surgery for Parkinson's disease (PD) and improve clinical treatment effect. Eighty patients with PD in Tianjin Medical University General Hospital were selected as the research objects and randomly divided into two groups. The three-dimensional mark point positioning algorithm was applied to perform feature positioning on the MRI images of PD patients, and the international unified Parkinson's disease rating scale (UPDRS) was assessed before and after single-target surgery of the two groups. There was a significant difference in the postoperative treatment effect between the two groups compared with the preoperative one (P < 0.05). Among the patients in the observation group, 37 cases were marked as markedly effective, accounting for 92.5% of the total group; 1 case was ineffective and 2 cases were improved, accounting for 2.5% and 5%, respectively. In the control group, 35, 2, and 3 cases were assessed as markedly effective, ineffective, and improved, accounting for 87.5%, 5%, and 7.5%, respectively. The overall curative effect of the observation group was better than that of the control group, and the difference was significant (P < 0.05). The MRI manifestations of PD patients were diversified. MRI under the three-dimensional mark point positioning algorithm had a high value for the stereotactic treatment of PD patients, which was beneficial to the clinical surgery.
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Survey of practice preferences in deep brain stimulation surgery in the United States. INTERDISCIPLINARY NEUROSURGERY 2022. [DOI: 10.1016/j.inat.2021.101463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Sevcencu C. Single-interface bioelectronic medicines - concept, clinical applications and preclinical data. J Neural Eng 2022; 19. [PMID: 35533654 DOI: 10.1088/1741-2552/ac6e08] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 05/08/2022] [Indexed: 11/12/2022]
Abstract
Presently, large groups of patients with various diseases are either intolerant, or irresponsive to drug therapies and also intractable by surgery. For several diseases, one option which is available for such patients is the implantable neurostimulation therapy. However, lacking closed-loop control and selective stimulation capabilities, the present neurostimulation therapies are not optimal and are therefore used as only "third" therapeutic options when a disease cannot be treated by drugs or surgery. Addressing those limitations, a next generation class of closed-loop controlled and selective neurostimulators generically named bioelectronic medicines seems within reach. A sub-class of such devices is meant to monitor and treat impaired functions by intercepting, analyzing and modulating neural signals involved in the regulation of such functions using just one neural interface for those purposes. The primary objective of this review is to provide a first broad perspective on this type of single-interface devices for bioelectronic therapies. For this purpose, the concept, clinical applications and preclinical studies for further developments with such devices are here analyzed in a narrative manner.
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Affiliation(s)
- Cristian Sevcencu
- National Institute for Research and Development of Isotopic and Molecular Technologies, 67-103 Donat Street, Cluj-Napoca, 400293, ROMANIA
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