Deep Brain Stimulation Lead Implantation Using a Customized Rapidly Manufactured Stereotactic Fixture with Submillimetric Euclidean Accuracy

Stereotact Funct Neurosurg. 2020;98(4):248-255. doi: 10.1159/000506959. Epub 2020 Jun 2.

Abstract

Background: The microTargetingTM MicrotableTM Platform is a novel stereotactic system that can be more rapidly fabricated than currently available 3D-printed alternatives. We present the first case series of patients who underwent deep brain stimulation (DBS) surgery guided by this platform and demonstrate its in vivo accuracy.

Methods: Ten patients underwent DBS at a single institution by the senior author and 15 leads were placed. The mean age was 69.1 years; four were female. The ventralis intermedius nucleus was targeted for patients with essential tremor and the subthalamic nucleus was targeted for patients with Parkinson's disease.

Results: Nine DBS leads in 6 patients were appropriately imaged to enable measurement of accuracy. The mean Euclidean electrode placement error (EPE) was 0.97 ± 0.37 mm, and the mean radial error was 0.80 ± 0.41 mm (n = 9). In the subset of CT scans performed greater than 1 month postoperatively (n = 3), the mean Euclidean EPE was 0.75 ± 0.17 mm and the mean radial error was 0.69 ± 0.17 mm. There were no surgical complications.

Conclusion: The MicrotableTM platform is capable of submillimetric accuracy in patients undergoing stereotactic surgery. It has achieved clinical efficacy in our patients without surgical complications and has demonstrated the potential for superior accuracy compared to both traditional stereotactic frames and other common frameless systems.

Keywords: Deep brain stimulation; Deep brain stimulation accuracy; Frameless stereotaxis; Functional neurosurgery; Movement disorder surgery; Stereotactic surgery; Stereotaxis.

MeSH terms

  • Aged
  • Deep Brain Stimulation / instrumentation
  • Deep Brain Stimulation / methods
  • Deep Brain Stimulation / standards*
  • Electrodes, Implanted / standards*
  • Essential Tremor / diagnostic imaging
  • Essential Tremor / surgery*
  • Female
  • Humans
  • Imaging, Three-Dimensional / methods
  • Imaging, Three-Dimensional / standards
  • Male
  • Middle Aged
  • Parkinson Disease / diagnostic imaging
  • Parkinson Disease / surgery*
  • Retrospective Studies
  • Stereotaxic Techniques / standards*
  • Subthalamic Nucleus / diagnostic imaging
  • Subthalamic Nucleus / surgery
  • Tomography, X-Ray Computed / methods
  • Tomography, X-Ray Computed / standards
  • Treatment Outcome
  • Ventral Thalamic Nuclei / diagnostic imaging
  • Ventral Thalamic Nuclei / surgery