Nexframe frameless stereotaxy with multitract microrecording: accuracy evaluated by frame-based stereotactic X-ray

Area of Science:

• Neurosurgery
• Medical Technology
• Neurological Surgery

Background:

• Image-guided systems enable frameless stereotactic surgery for deep brain stimulation (DBS).
• Neurophysiological identification is crucial for precise electrode placement in DBS.
• Multitract microrecording is an effective technique for optimizing electrode targeting.

Purpose of the Study:

• To evaluate the accuracy, usefulness, and disadvantages of the Nexframe frameless stereotaxy system combined with Ben's Gun multitract microrecording for subthalamic nucleus (STN) DBS.
• To compare the accuracy of the Nexframe system with conventional frame-based stereotaxy.

Main Methods:

• Five patients undergoing bilateral STN DBS were evaluated using the Nexframe system and multitract microrecording.
• A Leksell G frame and stereotactic X-ray system were used simultaneously for comparison.
• Electrode placement accuracy was measured and compared to frame-based stereotaxy data from 20 patients.

Main Results:

• The Nexframe system demonstrated mean deviations of 1.3 mm (x), 1.0 mm (y), and 0.5 mm (z) from planned targets.
• These deviations were not statistically different from frame-based stereotaxy (1.5 mm (x), 1.1 mm (y), 0.8 mm (z)).
• The multitract microrecording procedure was successful, with no electrode migration, but the narrow surgical field complicated multiple electrode insertion.

Conclusions:

• The Nexframe system with multitract microrecording for STN DBS shows accuracy comparable to frame-based stereotaxy.
• A significant disadvantage is the narrow surgical field, hindering multiple electrode insertion.
• Further improvements are needed to enhance the system's utility and potentially replace conventional methods.