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Stereotactic registration using cone-beam computed tomography.

Jonathan Dennis Carlson1

  • 1Inland Neurosurgery and Spine Associates, 105 West 8th Ave. Suite 200, Spokane, WA 99204, USA.

Clinical Neurology and Neurosurgery
|May 22, 2019
PubMed
Summary
This summary is machine-generated.

Intraoperative cone-beam computed tomography (CBCT) enables accurate stereotactic registration for deep brain stimulation (DBS) surgery. This advanced imaging streamlines the process, ensuring precise lead placement and saving valuable operating time.

Keywords:
Cone-Beam computed tomographyDeep brain stimulationStereotactic techniquesSurgical accuracy

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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.