Clinical accuracy of a customized stereotactic platform for deep brain stimulation after accounting for brain shift

Previous studies have evaluated the accuracy of several approaches for the placement of electrodes for deep brain stimulation. In this paper, we present a strategy to minimize the effect of brain shift on the estimation of the electrode placement error (EPE) for a stereotactic platform in the absence of intraoperative imaging data, and we apply it to the StarFix microTargeting Platform (FHC Inc., Bowdoin, Me., USA). This method involves comparing the intraoperative stereotactic coordinates of the implant with its position in the postoperative CT images in a population for which the effect of brain shift is minimal. The study we have conducted on 75 patients demonstrates that the EPE is overestimated at least by about 60% if brain shift is not taken into account, and shows a clinical accuracy of 1.24 +/- 0.37 mm for the StarFix frame, which is similar to the reported G frame accuracy and better than the reported Nexframe accuracy (2.5 +/- 1.4 mm) [Stereotact Funct Neurosurg 2007;85:235-242].