Background: Frameless stereotactic surgery utilizing fiducial-based (FB) registration is an established tool in the armamentarium of deep brain stimulation (DBS) surgeons. Fiducial-less (FL) registration via intraoperative CT, such as the O-arm, has been routinely used in spine surgery, but its accuracy for DBS surgery has not been studied in a clinical setting. Objective: We undertook a study to analyze the accuracy of the FL technique in DBS surgery and compare it to the FB method. Methods: In this prospective cohort study, 97 patients underwent DBS surgery using the NexFrame and the O-arm registration stereotactic system. Patients underwent FB (n = 50) registration from 2015 to 2016 and FL (n = 47) O-arm registration from 2016 to 2017. Results: The radial errors (RE) and vector/euclidean errors of FB and FL registration were not significantly different. There was no difference in additional passes between methods, but there was an increase in the number of RE ≥2.5 mm in the FL method. Conclusion: Although there was no statistically significant difference in RE or the need for additional passes, the increased number of errors ≥2.5 mm with the FL method (17 vs. 4% in FB) indicates the need for further study. We concluded that O-arm images of the implants should be utilized to assess and correct for this error.

1.
Henderson
JM
,
Holloway
KL
,
Gaede
SE
,
Rosenow
JM
.
The application accuracy of a skull-mounted trajectory guide system for image-guided functional neurosurgery
.
Comput Aided Surg
.
2004
;
9
(
4
):
155
60
.
[PubMed]
1092-9088
2.
Holloway
KL
,
Gaede
SE
,
Starr
PA
,
Rosenow
JM
,
Ramakrishnan
V
,
Henderson
JM
.
Frameless stereotaxy using bone fiducial markers for deep brain stimulation
.
J Neurosurg
.
2005
Sep
;
103
(
3
):
404
13
.
[PubMed]
0022-3085
3.
Kelman
C
,
Ramakrishnan
V
,
Davies
A
,
Holloway
K
.
Analysis of stereotactic accuracy of the cosman-robert-wells frame and nexframe frameless systems in deep brain stimulation surgery
.
Stereotact Funct Neurosurg
.
2010
;
88
(
5
):
288
95
.
[PubMed]
1011-6125
4.
Bot
M
,
van den Munckhof
P
,
Bakay
R
,
Sierens
D
,
Stebbins
G
,
Verhagen Metman
L
.
Analysis of Stereotactic Accuracy in Patients Undergoing Deep Brain Stimulation Using Nexframe and the Leksell Frame
.
Stereotact Funct Neurosurg
.
2015
;
93
(
5
):
316
25
.
[PubMed]
1011-6125
5.
Tai
CH
,
Wu
RM
,
Lin
CH
,
Pan
MK
,
Chen
YF
,
Liu
HM
, et al.
Deep brain stimulation therapy for Parkinson’s disease using frameless stereotaxy: comparison with frame-based surgery
.
Eur J Neurol
.
2010
Nov
;
17
(
11
):
1377
85
.
[PubMed]
1351-5101
6.
Sharma
M
,
Rhiew
R
,
Deogaonkar
M
,
Rezai
A
,
Boulis
N
.
Accuracy and precision of targeting using frameless stereotactic system in deep brain stimulator implantation surgery
.
Neurol India
.
2014
Sep-Oct
;
62
(
5
):
503
9
.
[PubMed]
0028-3886
7.
Brontë-Stewart
H
,
Louie
S
,
Batya
S
,
Henderson
JM
.
Clinical motor outcome of bilateral subthalamic nucleus deep-brain stimulation for Parkinson’s disease using image-guided frameless stereotaxy
.
Neurosurgery
.
2010
Oct
;
67
(
4
):
1088
93
.
[PubMed]
0148-396X
8.
Cheng
CY
,
Hsing
MT
,
Chen
YH
,
Wu
SL
,
Sy
HN
,
Chen
CM
, et al.
Deep brain stimulation for Parkinson’s disease using frameless technology
.
Br J Neurosurg
.
2014
Jun
;
28
(
3
):
383
6
.
[PubMed]
0268-8697
9.
Winkler
D
,
Hammer
N
,
Oehlwein
C
,
Schwarz
J
,
Strecker
K
,
Fritzsch
D
, et al.
Implementing conventional Zamorano Dujovny frames versus individually manufactured microTargeting platforms—a comparative study on deep brain stimulation in Parkinson patients
.
Stereotact Funct Neurosurg
.
2013
;
91
(
6
):
392
8
.
[PubMed]
1011-6125
10.
Medtronic Navigation, Inc.
StealthStation DBS and Stereotaxy Software Pocket Guide- instructions for stereotactic frame based, Nexframe, and StarFix procedures.
2016
.
11.
Geevarghese
R
,
O’Gorman Tuura
R
,
Lumsden
DE
,
Samuel
M
,
Ashkan
K
.
Registration Accuracy of CT/MRI Fusion for Localisation of Deep Brain Stimulation Electrode Position: An Imaging Study and Systematic Review
.
Stereotact Funct Neurosurg
.
2016
;
94
(
3
):
159
63
.
[PubMed]
1011-6125
12.
Holloway
K
,
Docef
A
.
A quantitative assessment of the accuracy and reliability of O-arm images for deep brain stimulation surgery
.
Neurosurgery
.
2013
Mar
;
72
(
1
Suppl Operative
):
47
57
.
[PubMed]
1524-4040
13.
Bender
R
,
Lange
S
.
Adjusting for multiple testing—when and how?
J Clin Epidemiol
.
2001
Apr
;
54
(
4
):
343
9
.
[PubMed]
0895-4356
14.
Starr
PA
,
Christine
CW
,
Theodosopoulos
PV
,
Lindsey
N
,
Byrd
D
,
Mosley
A
, et al.
Implantation of deep brain stimulators into the subthalamic nucleus: technical approach and magnetic resonance imaging-verified lead locations
.
J Neurosurg
.
2002
Aug
;
97
(
2
):
370
87
.
[PubMed]
0022-3085
15.
Ko
AL
,
Ibrahim
A
,
Magown
P
,
Macallum
R
,
Burchiel
KJ
.
Factors Affecting Stereotactic Accuracy in Image-Guided Deep Brain Stimulator Electrode Placement
.
Stereotact Funct Neurosurg
.
2017
;
95
(
5
):
315
24
.
[PubMed]
1011-6125
16.
Kochanski
RB
,
Bus
S
,
Pal
G
,
Metman
LV
,
Sani
S
.
Optimization of Microelectrode Recording in Deep Brain Stimulation Surgery Using Intraoperative Computed Tomography
.
World Neurosurg
.
2017
Jul
;
103
:
168
73
.
[PubMed]
1878-8750
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