Stereotactic registration using cone-beam computed tomography

Area of Science:

• Neurosurgery
• Medical Imaging
• Surgical Navigation

Background:

• Deep brain stimulation (DBS) surgery traditionally relies on post-operative imaging for stereotactic registration, often involving halo placement and fiducials on MRI or CT scans.
• Cone-beam computed tomography (CBCT) has been utilized for lead confirmation in DBS, but newer scanners with enlarged fields of view offer potential for intraoperative registration.

Purpose of the Study:

• To evaluate the accuracy and precision of stereotactic registration using intraoperative CBCT imaging.
• To compare the performance of CBCT-based registration with conventional CT-based registration in DBS surgery.

Main Methods:

• A retrospective study compared the registration accuracy and precision of CBCT (O-arm O2) against CT registration in 10 patients.
• Stereotactic coordinate differences were analyzed, and end-to-end accuracy of DBS lead placement was assessed on postoperative MRI in 31 leads using CBCT registration.

Main Results:

• The average radial distance for CBCT and CT registration was clinically comparable (0.46 ± 0.17 mm).
• CBCT registration demonstrated superior accuracy in maximum rod error (0.50 ± 0.12 mm) compared to CT registration (1.02 ± 0.63 mm) (P=0.018).
• Utilizing CBCT for registration saved an average of 26 minutes (P < 0.001), with an end-to-end radial error of 1.07 ± 0.67 mm on postoperative MRI.

Conclusions:

• Stereotactic registration using intraoperative CBCT images is accurate and precise.
• This CBCT workflow results in accurate and precise deep brain stimulation lead placement, offering significant time savings.