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Stereotactic Accuracy and Technique Utilizing the SmartFrame OR Platform with Stereotactic Navigation and Cone Beam
Kishore Balasubramanian1,2, Helen Shi1, Tressie M Stephens1
1Department of Neurosurgery, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma, USA.
Stereotactic and Functional Neurosurgery
|December 9, 2025
Summary
This study demonstrates that the ClearPoint SmartFrame OR system enables accurate asleep deep brain stimulation (DBS) without MRI. This frameless stereotaxy approach improves accessibility and precision in standard operating rooms.
Area of Science:
- Neurosurgery
- Medical Devices
- Neurological Surgery
Background:
- Deep brain stimulation (DBS) accuracy is often limited by the need for intraoperative MRI.
- Frameless stereotaxy combined with optical navigation and intraoperative CT (iCT) offers a potential solution for asleep DBS.
- This approach aims to enhance the accessibility and precision of DBS procedures in standard operating rooms.
Purpose of the Study:
- To evaluate the accuracy and efficiency of the ClearPoint SmartFrame OR system for asleep DBS electrode placement.
- To assess the feasibility of using a frameless stereotaxy system with O-arm imaging and neuronavigation for DBS in standard operating rooms.
Main Methods:
- A retrospective analysis of 33 asleep DBS procedures in 32 patients using the ClearPoint SmartFrame OR system.
- Assessment of radial targeting error and operative duration.
- Integration of O-arm imaging and StealthStation neuronavigation for surgical workflow.
Main Results:
- Median radial targeting error was 0.40 mm, demonstrating submillimeter accuracy.
- The ventral intermediate nucleus (VIM) showed the highest precision (0.35 mm).
- Median operative time was 189 minutes, with no major complications or required revisions.
Conclusions:
- The ClearPoint SmartFrame OR system provides submillimeter accuracy for asleep DBS, comparable to MRI-guided methods.
- This MRI-independent approach enhances accessibility, reduces costs, and maintains safety in standard neurosurgical settings.
- The system represents a scalable solution for widespread adoption of asleep DBS.
