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A Comparative Study of Fiducial-Based and Fiducial-Less Registration Utilizing the O-Arm
Jamie Toms1,2, Sheyne Martin2, Adam P Sima3
1Department of Neurosurgery, Virginia Commonwealth University, Richmond, Virginia, USA.
Stereotactic and Functional Neurosurgery
|May 16, 2019
Summary
Fiducial-less (FL) registration for deep brain stimulation (DBS) surgery showed similar accuracy to fiducial-based (FB) methods, but with a higher rate of significant errors. Further research is needed to refine FL techniques for DBS procedures.
Area of Science:
- Neurosurgery
- Medical Imaging
- Surgical Navigation
Background:
- Frameless stereotactic surgery for deep brain stimulation (DBS) commonly uses fiducial-based (FB) registration.
- Fiducial-less (FL) registration, utilizing intraoperative CT like the O-arm, is established in spine surgery but its accuracy for DBS is not well-studied.
Purpose of the Study:
- To analyze and compare the accuracy of fiducial-less (FL) registration versus fiducial-based (FB) registration in deep brain stimulation (DBS) surgery.
Main Methods:
- A prospective cohort study involving 97 patients undergoing DBS surgery with the NexFrame and O-arm system.
- FB registration was used in 50 patients (2015-2016), and FL O-arm registration in 47 patients (2016-2017).
Main Results:
- Radial errors (RE) and vector/Euclidean errors did not significantly differ between FB and FL registration methods.
- No difference in the need for additional surgical passes was observed.
- A higher incidence of RE ≥2.5 mm was noted with the FL method (17%) compared to FB (4%).
Conclusions:
- While overall accuracy and need for additional passes were similar, the increased rate of significant errors (≥2.5 mm) with FL registration warrants further investigation.
- Utilization of O-arm intraoperative images is recommended for assessing and correcting potential errors in FL-based DBS surgery.
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