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Intraoperative 3D fluoroscopy accurately predicts final electrode position in deep brain stimulation surgery
Patrícia Neto-Fernandes1,2, Clara Chamadoira2,3, Carolina Silva2,3
1Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal.
Acta Neurochirurgica
|August 6, 2024
Summary
Intraoperative 3D fluoroscopy (3DF) accurately confirms deep brain stimulation (DBS) electrode placement, offering a faster, safer alternative to CT scans. This method reduces radiation exposure and avoids patient transport, streamlining surgical procedures.
Area of Science:
- Neurosurgery
- Medical Imaging
- Radiology
Background:
- Current deep brain stimulation (DBS) electrode placement confirmation relies on intraoperative CT or MRI, necessitating patient transport and extending surgery duration.
- This reliance on external imaging units creates logistical challenges and delays in the surgical workflow.
Purpose of the Study:
- To validate intraoperative 3D fluoroscopy (3DF) as a reliable method for determining final DBS electrode position.
- To assess the feasibility of using 3DF as a replacement for postoperative CT scans in DBS procedures.
Main Methods:
- A retrospective study analyzed 64 patients (124 electrodes) who underwent DBS surgery.
- Intraoperative 3DF and postoperative volumetric CT scans were acquired for comparison of electrode tip coordinates.
- Analysis included assessment of pneumocephalus impact and comparison of radiation exposure between 3DF and CT.
Main Results:
- The difference in electrode tip position between 3DF and CT was minimal (0.85 ± 0.03 mm) and highly correlated (p < 0.0001).
- Pneumocephalus, though larger in the 3DF group, did not significantly impact electrode position accuracy.
- Radiation exposure was significantly lower with 3DF (0.36 ± 0.03 mSv) compared to CT (2.08 ± 0.05 mSv).
Conclusions:
- Intraoperative 3DF is a comparable and valid method for confirming DBS electrode position.
- 3DF offers advantages including reduced radiation exposure, lower cost, faster procedure times, and elimination of patient transport.
- Intraoperative 3DF can effectively replace postoperative CT scans for DBS electrode placement verification.
