Surgical Technique for Repositioning Deep Brain Stimulation Electrodes

Area of Science:

• Neurosurgery
• Robotic Surgery
• Medical Imaging

Background:

• Deep brain stimulation (DBS) electrode placement accuracy is crucial for surgical success.
• A systematic approach for repositioning DBS electrodes with suboptimal first-pass accuracy, especially in asleep DBS surgery, is lacking in current literature.

Purpose of the Study:

• To evaluate the reliability of using the direction and magnitude of initial radial error to guide repositioning of DBS electrodes.
• To analyze the reproducibility of systematic errors in DBS electrode placement.

Main Methods:

• Retrospective analysis of DBS procedures using an image-guided, image-verified robotic technique (July 2018 - November 2024).
• Surgical repositioning technique based on the direction and magnitude of first-pass radial error, measured via intraoperative O-arm CT.
• Analysis of 506 passes for 441 electrodes.

Main Results:

• Final radial error after repositioning averaged 0.96 ± 0.38 mm, comparable to existing literature.
• The direction of radial error was consistent between the first and second passes in 71.74% of revisions, indicating reproducibility.
• The relationship between initial and subsequent radial error direction was statistically significant (P < .001).

Conclusions:

• The direction and magnitude of initial radial error in DBS electrode placement can be reliably used for accurate correction.
• Suboptimal electrode placement likely results from reproducible systematic errors influenced by procedural and patient-specific anatomical factors.