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Intraoperative computed tomography for deep brain stimulation surgery: technique and accuracy assessment
Kiarash Shahlaie1, Paul S Larson, Philip A Starr
1Department of Neurological Surgery, University of California, San Francisco, and Parkinson's Disease Research, Education, and Care Center, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA.
Neurosurgery
|January 6, 2011
Summary
Intraoperative computed tomography (iCT) accurately confirms deep brain stimulation (DBS) lead placement during surgery. This method enhances precision and may eliminate the need for routine postoperative MRI scans.
Area of Science:
- Neurosurgery
- Medical Imaging
- Neurological Surgery
Background:
- Deep brain stimulation (DBS) efficacy relies heavily on precise lead placement.
- Accurate electrode positioning is critical for successful DBS outcomes.
Purpose of the Study:
- To evaluate the utility of intraoperative computed tomography (iCT) for confirming deep brain stimulation (DBS) lead placement.
- To assess the accuracy of iCT in guiding lead localization before surgical closure.
Main Methods:
- Fifteen patients undergoing awake microelectrode-guided DBS surgery utilized a portable iCT scanner (Medtronic O-arm).
- iCT images were fused with preoperative MRI to determine lead tip coordinates, compared against postoperative MRI.
- Techniques for optimal head positioning and fixation for unobstructed iCT imaging were employed.
Main Results:
- iCT integration into DBS surgery minimally impacted surgical time and complexity.
- High-quality 2D and 3D iCT images were obtained in all cases.
- Lead tip measurements using iCT fused with MRI were statistically equivalent to those from postoperative MRI.
Conclusions:
- Intraoperative CT (iCT) offers accurate 3D confirmation of DBS electrode tip location, replacing C-arm fluoroscopy.
- iCT fused with preoperative MRI may render routine postoperative MRI unnecessary for DBS procedures.
- Efficient iCT use in DBS surgery requires mastering specific technical nuances.
