scholarly journals Targeting accuracy of robot-assisted deep brain stimulation surgery in childhood-onset dystonia: a single-center prospective cohort analysis of 45 consecutive cases

2021 ◽  
pp. 1-11
Author(s):  
Luciano Furlanetti ◽  
Jonathan Ellenbogen ◽  
Hortensia Gimeno ◽  
Laura Ainaga ◽  
Vijay Narbad ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Euclidean Distance ◽  
Electrode Position ◽  
Age Group ◽  
Childhood Onset ◽  
Robot Assisted ◽  
Radial Error ◽  
Stereotactic Implantation ◽  
Deep Brain

OBJECTIVE Deep brain stimulation (DBS) is an established treatment for pediatric dystonia. The accuracy of electrode implantation is multifactorial and remains a challenge in this age group, mainly due to smaller anatomical targets in very young patients compared to adults, and also due to anatomical abnormalities frequently associated with some etiologies of dystonia. Data on the accuracy of robot-assisted DBS surgery in children are limited. The aim of the current paper was to assess the accuracy of robot-assisted implantation of DBS leads in a series of patients with childhood-onset dystonia. METHODS Forty-five children with dystonia undergoing implantation of DBS leads under general anesthesia between 2017 and 2019 were included. Robot-assisted stereotactic implantation of the DBS leads was performed. The final position of the electrodes was verified with an intraoperative 3D scanner (O-arm). Coordinates of the planned electrode target and actual electrode position were obtained and compared, looking at the radial error, depth error, absolute error, and directional error, as well as the euclidean distance. Functional assessment data prospectively collected by a multidisciplinary pediatric complex motor disorders team were analyzed with regard to motor skills, individualized goal achievement, and patients’ and caregivers’ expectations. RESULTS A total of 90 DBS electrodes were implanted and 48.5% of the patients were female. The mean age was 11.0 ± 0.6 years (range 3–18 years). All patients received bilateral DBS electrodes into the globus pallidus internus. The median absolute errors in x-, y-, and z-axes were 0.85 mm (range 0.00–3.25 mm), 0.75 mm (range 0.05–2.45 mm), and 0.75 mm (range 0.00–3.50 mm), respectively. The median euclidean distance from the target to the actual electrode position was 1.69 ± 0.92 mm, and the median radial error was 1.21 ± 0.79. The robot-assisted technique was easily integrated into the authors’ surgical practice, improving accuracy and efficiency, and reducing surgical time significantly along the learning curve. No major perioperative complications occurred. CONCLUSIONS Robot-assisted stereotactic implantation of DBS electrodes in the pediatric age group is a safe and accurate surgical method. Greater accuracy was present in this cohort in comparison to previous studies in which conventional stereotactic frame-based techniques were used. Robotic DBS surgery and neuroradiological advances may result in further improvement in surgical targeting and, consequently, in better clinical outcome in the pediatric population.

Stereotactic Accuracy and Surgical Utility of the O-Arm in Deep Brain Stimulation Surgery

2016 ◽  
Vol 13 (1) ◽  
pp. 96-107 ◽  
Author(s):  
Jonathan Dennis Carlson ◽  
Kate Elizabeth McLeod ◽  
Pamela Sue McLeod ◽  
Jamelynn Brooke Mark
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Intraoperative Imaging ◽  
Electrode Placement ◽  
Electrode Position ◽  
Radial Error ◽  
Postoperative Mri ◽  
Magnetic Resonance Imaging Mri ◽  
The Impact ◽  
Deep Brain

Abstract BACKGROUND: The stereotactic accuracy of intraoperative imaging is critical to clinical outcome, particularly in “asleep” deep brain stimulation (DBS) surgery that typically forgoes neurophysiological techniques. Different intraoperative imaging modalities and associated accuracies have been reported, including magnetic resonance imaging (MRI), computed tomography (CT), and O-arm. OBJECTIVE: To analyze intraoperative O-arm imaging accuracy and to evaluate the utility of microelectrode mapping. METHODS: O-arm images of DBS electrodes were collected during implantation in the subthalamic nucleus in patients with Parkinson disease. Images were fused to postoperative MRI and postoperative CT scans. Stereotactic coordinates for the electrode tip were measured independently. Radial distances between the images were compared. The impact of microelectrode mapping on final DBS electrode positioning was also evaluated. RESULTS: In 71 consecutive DBS electrodes, the average radial error of the electrode tip between the O-arm and MRI was 1.55 ± 0.58 mm. The average radial error between the O-arm and CT was 1.03 ± 0.61 mm. Thus, the O-arm images accurately depicted the position of the electrode. However, in 14% of cases, microelectrode mapping revised the DBS electrode position beyond the preoperative direct target in combination with accurate intraoperative imaging. CONCLUSION: Intraoperative O-arm images reliably and accurately displayed the location of the DBS electrode compared with postoperative CT and MRI images. Microelectrode mapping provided superior subnuclear resolution to imaging. Both intraoperative imaging and microelectrode mapping are effective tools that can be synergistically combined for optimal DBS electrode placement.

Frameless Robot-Assisted Deep Brain Stimulation Surgery: An Initial Experience

2019 ◽  
Vol 17 (4) ◽  
pp. 424-431 ◽  
Author(s):  
Allen L Ho ◽  
Arjun V Pendharkar ◽  
Ryan Brewster ◽  
Derek L Martinez ◽  
Richard A Jaffe ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Positive Impact ◽  
Initial Experience ◽  
Robot Assisted ◽  
Radial Error ◽  
Historic Control ◽  
Improving Accuracy ◽  
Deep Brain Stimulation Surgery ◽  
Deep Brain

Abstract BACKGROUND Modern robotic-assist surgical systems have revolutionized stereotaxy for a variety of procedures by increasing operative efficiency while preserving and even improving accuracy and safety. However, experience with robotic systems in deep brain stimulation (DBS) surgery is scarce. OBJECTIVE To present an initial series of DBS surgery performed utilizing a frameless robotic solution for image-guided stereotaxy, and report on operative efficiency, stereotactic accuracy, and complications. METHODS This study included the initial 20 consecutive patients undergoing bilateral robot-assisted DBS. The prior 20 nonrobotic, frameless cohort of DBS cases was sampled as a baseline historic control. For both cohorts, patient demographic and clinical data were collected including postoperative complications. Intraoperative duration and number of Microelectrode recording (MER) and final lead passes were recorded. For the robot-assisted cohort, 2D radial errors were calculated. RESULTS Mean case times (total operating room, anesthesia, and operative times) were all significantly decreased in the robot-assisted cohort (all P-values < .02) compared to frameless DBS. When looking at trends in case times, operative efficiency improved over time in the robot-assisted cohort across all time assessment points. Mean radial error in the robot-assisted cohort was 1.40 ± 0.11 mm, and mean depth error was 1.05 ± 0.18 mm. There was a significant decrease in the average number of MER passes in the robot-assisted cohort (1.05) compared to the nonrobotic cohort (1.45, P < .001). CONCLUSION This is the first report of application of frameless robotic-assistance with the Mazor Renaissance platform (Mazor Robotics Ltd, Caesarea, Israel) for DBS surgery, and our findings reveal that an initial experience is safe and can have a positive impact on operative efficiency, accuracy, and safety.

Frameless ROSA® Robot-Assisted Lead Implantation for Deep Brain Stimulation: Technique and Accuracy

2019 ◽  
Vol 19 (1) ◽  
pp. 57-64 ◽  
Author(s):  
Lannie Liu ◽  
Sarah Giulia Mariani ◽  
Emmanuel De Schlichting ◽  
Sylvie Grand ◽  
Michel Lefranc ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Ct Scans ◽  
X Rays ◽  
Robot Assisted ◽  
Lead Position ◽  
The Mean ◽  
Group 2 ◽  
Deep Brain ◽  
Group 1

Abstract BACKGROUND Frameless robotic-assisted surgery is an innovative technique for deep brain stimulation (DBS) that has not been assessed in a large cohort of patients. OBJECTIVE To evaluate accuracy of DBS lead placement using the ROSA® robot (Zimmer Biomet) and a frameless registration. METHODS All patients undergoing DBS surgery in our institution between 2012 and 2016 were prospectively included in an open label single-center study. Accuracy was evaluated by measuring the radial error (RE) of the first stylet implanted on each side and the RE of the final lead position at the target level. RE was measured on intraoperative telemetric X-rays (group 1), on intraoperative O-Arm® (Medtronic) computed tomography (CT) scans (group 2), and on postoperative CT scans or magnetic resonance imaging (MRI) in both groups. RESULTS Of 144 consecutive patients, 119 were eligible for final analysis (123 DBS; 186 stylets; 192 leads). In group 1 (76 patients), the mean RE of the stylet was 0.57 ± 0.02 mm, 0.72 ± 0.03 mm for DBS lead measured intraoperatively, and 0.88 ± 0.04 mm for DBS lead measured postoperatively on CT scans. In group 2 (43 patients), the mean RE of the stylet was 0.68 ± 0.05 mm, 0.75 ± 0.04 mm for DBS lead measured intraoperatively; 0.86 ± 0.05 mm and 1.10 ± 0.08 mm for lead measured postoperatively on CT scans and on MRI, respectively No statistical difference regarding the RE of the final lead position was found between the different intraoperative imaging modalities and postoperative CT scans in both groups. CONCLUSION Frameless ROSA® robot-assisted technique for DBS reached submillimeter accuracy. Intraoperative CT scans appeared to be reliable and sufficient to evaluate the final lead position.

scholarly journals An Assessment of Current Brain Targets for Deep Brain Stimulation Surgery With Susceptibility-Weighted Imaging at 7 Tesla

Neurosurgery ◽  
2010 ◽  
Vol 67 (6) ◽  
pp. 1745-1756 ◽  
Author(s):  
Aviva Abosch ◽  
Essa Yacoub ◽  
Kamil Ugurbil ◽  
Noam Harel
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Image Resolution ◽  
7 Tesla ◽  
Patient Specific ◽  
Susceptibility Weighted Imaging ◽  
Target Area ◽  
Electrode Position ◽  
Microelectrode Recording ◽  
Deep Brain

Abstract BACKGROUND: Deep brain stimulation (DBS) surgery is used for treating movement disorders, including Parkinson disease, essential tremor, and dystonia. Successful DBS surgery is critically dependent on precise placement of DBS electrodes into target structures. Frequently, DBS surgery relies on normalized atlas-derived diagrams that are superimposed on patient brain magnetic resonance imaging (MRI) scans, followed by microelectrode recording and macrostimulation to refine the ultimate electrode position. Microelectrode recording carries a risk of hemorrhage and requires active patient participation during surgery. OBJECTIVE: To enhance anatomic imaging for DBS surgery using high-field MRI with the ultimate goal of improving the accuracy of anatomic target selection. METHODS: Using a 7-T MRI scanner combined with an array of acquisition schemes using multiple image contrasts, we obtained high-resolution images of human deep nuclei in healthy subjects. RESULTS: Superior image resolution and contrast obtained at 7 T in vivo using susceptibility-weighted imaging dramatically improved anatomic delineation of DBS targets and allowed the identification of internal architecture within these targets. A patient-specific, 3-dimensional model of each target area was generated on the basis of the acquired images. CONCLUSION: Technical developments in MRI at 7 T have yielded improved anatomic resolution of deep brain structures, thereby holding the promise of improving anatomic-based targeting for DBS surgery. Future study is needed to validate this technique in improving the accuracy of targeting in DBS surgery.

Neuromodulation in Childhood Onset Dystonia: Evolving Role of Deep Brain Stimulation

2020 ◽  
Vol 8 (2) ◽  
pp. 37-43
Author(s):  
Warren A. Marks ◽  
Stephanie Acord ◽  
Laurie Bailey ◽  
John Honeycutt
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Childhood Onset ◽  
Deep Brain

Pediatric Deep Brain Stimulation for Dystonia: Current State and Ethical Considerations

2020 ◽  
Vol 29 (4) ◽  
pp. 557-573
Author(s):  
KATRINA A. MUÑOZ ◽  
JENNIFER BLUMENTHAL-BARBY ◽  
ERIC A. STORCH ◽  
LAURA TORGERSON ◽  
GABRIEL LÁZARO-MUÑOZ
Keyword(s):  
Quality Of Life ◽  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
The United States ◽  
Childhood Onset ◽  
Ethical Considerations ◽  
Current State ◽  
Limited Effectiveness ◽  
Deep Brain

AbstractDystonia is a movement disorder that can have a debilitating impact on motor functions and quality of life. There are 250,000 cases in the United States, most with childhood onset. Due to the limited effectiveness and side effects of available treatments, pediatric deep brain stimulation (pDBS) has emerged as an intervention for refractory dystonia. However, there is limited clinical and neuroethics research in this area of clinical practice. This paper examines whether it is ethically justified to offer pDBS to children with refractory dystonia. Given the favorable risk-benefit profile, it is concluded that offering pDBS is ethically justified for certain etiologies of dystonia, but it is less clear for others. In addition, various ethical and policy concerns are discussed, which need to be addressed to optimize the practice of offering pDBS for dystonia. Strategies are proposed to help address these concerns as pDBS continues to expand.

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