Frameless stereotaxy using bone fiducial markers for deep brain stimulation

Area of Science:

• Neurosurgery
• Medical device technology
• Image-guided surgery

Background:

• Stereotactic frames are traditional tools for deep brain stimulation (DBS) surgery.
• Frameless techniques are emerging as alternatives, with prior phantom studies suggesting high accuracy.

Purpose of the Study:

• To evaluate the clinical accuracy of a frameless DBS system compared to a traditional frame-based system.

Main Methods:

• Deep brain stimulation leads were implanted in 38 patients using a frameless, image-guided system with bone fiducial markers.
• Postoperative CT scans were used to compare actual lead positions with planned trajectories.
• Accuracy data were compared against published data from a frame-based system (Leksell frame).

Main Results:

• The mean differences between planned and actual lead positions were comparable across both systems in the x, y, and z planes.
• Specifically, differences in the x-plane were 1.4 mm (frame-based) vs. 1.6 mm (frameless), y-plane 1.6 mm vs. 1.3 mm, and z-plane 1.7 mm vs. 2 mm.
• Multivariate analysis of variance showed no statistically significant difference in accuracy between the frame-based and frameless methods (p = 0.22).

Conclusions:

• Frameless and frame-based systems demonstrate comparable accuracy for deep brain stimulation lead implantation in clinical practice.
• Frameless techniques offer potential benefits including enhanced patient comfort, flexible imaging-surgery timing, and shorter operating durations.