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Updated: Jun 2, 2026

Intra-Operative Behavioral Tasks in Awake Humans Undergoing Deep Brain Stimulation Surgery
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Published on: January 6, 2011

Frameless deep brain stimulation using intraoperative O-arm technology. Clinical article.

Adam P Smith1, Roy A E Bakay

  • 1Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA. Adam_Smith@rush.edu

Journal of Neurosurgery
|April 19, 2011
PubMed
Summary

This study shows that O-arm intraoperative CT (iCT) can help approximate deep brain stimulation (DBS) lead placement during frameless surgery, potentially reducing radiation exposure. However, electrophysiological testing remains crucial for precise lead localization.

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Area of Science:

  • Neurosurgery
  • Medical Imaging
  • Neurological Surgery

Background:

  • Accurate deep brain stimulation (DBS) lead placement is critical for successful surgical outcomes.
  • Intraoperative imaging modalities like CT and MRI are used to verify lead position, but their utility in frameless DBS procedures is still evolving.
  • O-arm intraoperative CT (iCT) offers 3D imaging capabilities during surgery.

Purpose of the Study:

  • To evaluate the utility of O-arm iCT in frameless DBS procedures for intraoperative lead localization.
  • To compare the accuracy of O-arm iCT-determined lead locations with postoperative imaging.
  • To assess the impact of O-arm iCT on radiation exposure compared to traditional methods.

Main Methods:

  • A series of 12 patients undergoing frameless DBS with 15 leads utilized O-arm iCT alongside electrophysiological testing.

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  • Intraoperative 3D CT scans were fused with preoperative MRI to guide microelectrode recording (MER) and confirm final lead placement.
  • Lead tip coordinates from planning, intraoperative iCT, and postoperative MRI were compared using Euclidean distances.

    • Main Results:

    • Mean Euclidean distances between planned, intraoperative, and postoperative lead locations were statistically significant (p < 0.0052).
    • Image fusion showed good accuracy with minimal postoperative brain shift.
    • O-arm iCT resulted in significantly lower radiation exposure compared to standard fluoroscopy and radiography (p < 0.0001).

    Conclusions:

    • O-arm iCT can be a valuable tool for approximating lead and microelectrode positions in frameless DBS surgery.
    • Electrophysiological testing remains essential for precise intraoperative localization, especially in areas where it is most effective.
    • O-arm iCT may offer benefits in targeting specific brain regions where electrophysiology is less reliable and appears to reduce radiation exposure.