Implementation of intraoperative computed tomography for deep brain stimulation: pitfalls and optimization of workflow, accuracy, and radiation exposure.

Implementation of intraoperative computed tomography for deep brain stimulation: pitfalls and optimization of workflow, accuracy, and radiation exposure.

World Neurosurg. 2018 Dec 26;:

Authors: Carl B, Bopp M, Gjorgjevski M, Oehrn C, Timmermann L, Nimsky C

Abstract
OBJECTIVE: Deep brain stimulation (DBS) is an effective treatment for movement disorders. Stereotactic electrode placement can be guided by intraoperative imaging, which also allows an immediate intraoperative quality control. This paper is about implementation and refining a workflow applying intraoperative computed tomography (iCT) for DBS.
METHODS: 18 patients underwent DBS with bilateral implantation of directional electrodes applying a 32-slice movable CT scanner in combination with microelectrode recording.
RESULTS: iCT led to a significant decrease in overall procedural time, despite performing multiple scans. In three of the initial 5 cases iCT caused an adjustment of the final electrodes demonstrating the learning curve and the necessity to integrate road mapping for the exchange of microelectrode to final electrode. Implementation of low-dose CT protocols added microelectrode iCT to the refined workflow, resulting in an intraoperative adjustment of a trajectory in one patient. Low-dose protocols lowered the total effective dose to 1.15 mSv, i.e. a reduction by a factor of 3.5 compared to a standard non-iCT DBS procedure, despite repeated iCTs. Intraoperative lead detection based on final iCT revealed a radial error of 1.04 ± 0.58 mm and a vector error of 2.28 ± 0.97 mm compared to the preoperative planning, adjusted by the findings of microelectrode recording.
CONCLUSIONS: iCT can be easily integrated into the surgical workflow resulting in an overall efficient time saving procedure. Repeated intraoperative scanning ensures reliable electrode placement, while low-dose scanning protocols prevent extensive radiation exposure. iCT of microelectrodes is feasible and led to an adjustment of one electrode.

PMID: 30593970 [PubMed - as supplied by publisher]

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