Factors Affecting Stereotactic Accuracy in Image-Guided Deep Brain Stimulator Electrode Placement

Area of Science:

• Neurosurgery
• Medical Imaging
• Neurological Surgery

Background:

• Intraoperative imaging enables real-time assessment of stereotactic accuracy during deep brain stimulation (DBS) electrode implantation.
• This technology is crucial for evaluating factors that influence stereotactic error.

Purpose of the Study:

• To analyze the impact of different anatomical targets on stereotactic accuracy during DBS electrode placement.
• To quantify the magnitude and direction of stereotactic errors based on target location and surgical approach.

Main Methods:

• Retrospective review of intraoperative CT imaging in patients undergoing DBS placement.
• Comparison of planned target coordinates with actual electrode positions to determine stereotactic error.
• Analysis of error based on implantation side, target (GPi, STN, Vim), and electrode approach angles.

Main Results:

• Analysis of 169 leads in 94 patients revealed an average Euclidean error of 1.63 mm.
• Vim targets showed higher error (1.95 mm) than GPi (1.44 mm); STN error (1.65 mm) was not significantly different.
• Vim and STN targets were more prone to medial deviation compared to GPi targets; coronal approach angle influenced Vim targeting error.

Conclusions:

• The anatomical target significantly affects the accuracy of DBS electrode placement.
• Targeting the Vim nucleus is associated with increased Euclidean error and medial deviation.
• These target-specific systematic deviations must be considered during the surgical planning and execution of DBS electrode implantation.