Accuracy of frame-based and frameless systems for deep brain stimulation: A meta-analysis

Area of Science:

• Neurosurgery
• Neurology
• Medical Engineering

Background:

• Deep brain stimulation (DBS) is a key treatment for movement disorders, requiring precise lead placement in the basal ganglia.
• Frame-based stereotaxy has been the traditional standard for accurate DBS lead implantation.
• Emerging frameless systems aim to provide comparable accuracy without the use of a stereotactic frame.

Purpose of the Study:

• To conduct a meta-analysis comparing the targeting accuracy of frameless versus frame-based stereotactic systems for DBS lead placement.
• To quantitatively assess the differences in electrode placement error across cardinal directions (x, y, z) between the two systems.

Main Methods:

• Systematic literature search identifying studies reporting DBS targeting accuracy for both frameless and frame-based methods.
• Inclusion of 5 relevant studies after screening 76 papers, evaluating a total of 425 DBS electrode placements.
• Statistical analysis using standard difference of means to compare targeting errors between frameless and frame-based stereotaxy.

Main Results:

• Frame-based stereotaxy demonstrated statistically significant accuracy benefits in the x (p=0.036) and y (p=0.0025) coordinates.
• No significant difference in targeting accuracy was observed for the z coordinate between the two methods.
• Composite mean differences in error were minimal: 0.3037 mm (x), 0.0305 mm (y), and 0.1630 mm (z).

Conclusions:

• Frameless stereotactic systems are a reasonable alternative to frame-based methods for DBS surgery.
• Although statistically significant accuracy differences exist favoring frame-based systems, the magnitude of these differences is very small.
• The observed small discrepancies in accuracy are likely of questionable clinical significance, supporting the use of frameless DBS techniques.