Intraoperative 3D imaging control during subthalamic Deep Brain Stimulation procedures using O-arm® technology

Intraoperative 3D imaging control during subthalamic Deep Brain Stimulation procedures using O-arm® technology- Experience in 15 patients

Neurochirurgie 60(2014)276–282

O-arm® now gives us the opportunity not only to perform 2D but also 3D scans during deep brain stimulation (DBS) procedures. We present our experience with the intraoperative use of this device. Our objective was to measure the geometrical accuracy of electrode placement during surgical procedures driven under O-arm® control.

Methods. Fifteen patients underwent STN-DBS.  For  the first 4 patients, 3D  scans were performed at the end of the procedure. We  calculated the accuracy of electrode positioning, i.e. the distance between final electrode positioning and the planned trajectory. For  the next 11  patients, who underwent both intraoperative and final 3D scan, we also calculated the accuracy of the microelectrode positioning.

Results. Average stimulation-induced improvement of UPDRS-III  score was 52.5 ± 15%. For  the first 4 patients, the mean electrode positioning accuracy was 1.46 ± 0.56 mm. For the 11  patients who underwent intraoperative 3D scan, the mean microelectrodes positioning accuracy was 1.59 ± 1.1 mm. Aberrant positioning was detected in two cases, and was analyzed by fusing 3D scan with preoperative MR images. The definite electrodes positioning accuracy was 1.05 ± 0.54 mm.

Conclusion. Intraoperative 3D scan is feasible, and can help us detect and correct early aberrant trajectories.