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Improved surgical procedure using intraoperative navigation for the implantation of the SPG microstimulator in patients with chronic cluster headache

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International Journal of Computer Assisted Radiology and Surgery Aims and scope Submit manuscript

Abstract

Introduction

The ATI SPG microstimulator is designed to be fixed on the posterior maxilla, with the integrated lead extending into the pterygopalatine fossa to electrically stimulate the sphenopalatine ganglion (SPG) as a treatment for cluster headache. Preoperative surgical planning to ensure the placement of the microstimulator in close proximity (within 5 mm) to the SPG is critical for treatment efficacy. The aim of this study was to improve the surgical procedure by navigating the initial dissection prior to implantation using a passive optical navigation system and to match the post-operative CBCT images with the preoperative treatment plan to verify the accuracy of the intraoperative placement of the microstimulator.

Methods

Custom methods and software were used that result in a 3D rotatable digitally reconstructed fluoroscopic image illustrating the patient-specific placement with the ATI SPG microstimulator. Those software tools were preoperatively integrated with the planning software of the navigation system to be used intraoperatively for navigated placement. Intraoperatively, the SPG microstimulator was implanted by completing the initial dissection with CT navigation, while the final position of the stimulator was verified by 3D CBCT. Those reconstructed images were then immediately matched with the preoperative CT scans with the digitally inserted SPG microstimulator. This method allowed for visual comparison of both CT scans and verified correct positioning of the SPG microstimulator.

Results

Twenty-four surgeries were performed using this new method of CT navigated assistance during SPG microstimulator implantation. Those results were compared to results of 21 patients previously implanted without the assistance of CT navigation. Using CT navigation during the initial dissection, an average distance reduction of 1.2 mm between the target point and electrode tip of the SPG microstimulator was achieved. Using the navigation software for navigated implantation and matching the preoperative planned scans with those performed post-operatively, the average distance was 2.17 mm with navigation, compared to 3.37 mm in the 28 surgeries without navigation.

Conclusion

Results from this new procedure showed a significant reduction (p = 0.009) in the average distance from the SPG microstimulator to the desired target point. Therefore, a distinct improvement could be achieved in positioning of the SPG microstimulator through the use of intraoperative navigation during the initial dissection and by post-operative matching of pre- and post-operatively performed CBCT scans.

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Authors and Affiliations

  1. Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg Eppendorf, University of Hamburg, Martinistr. 52, 20246, Hamburg, Germany

    Carsten Kohlmeier, Max Heiland & Alexandre T. Assaf

  2. Interdisciplinary Pain Center, University Hospital Freiburg, University of Freiburg, Breisacherstraße 64, 79106, Freiburg, Germany

    Peter Behrens

  3. Department of Neurology, Pain Clinic, Red Cross Hospital Kassel, Hansteinstrasse 29, 34121, Kassel, Germany

    Andreas Böger

  4. Autonomic Technologies, Inc., Redwood City, CA, USA

    Brinda Ramachandran & Anthony Caparso

  5. Digitales Diagnostikzentrum Breisgau, Kaiser-Joseph-Straße 263, 79098, Freiburg, Germany

    Dirk Schulze

  6. Department of Neurology, University Hospital Bergmannsheil, University of Bochum, Buerkle-de-la-Camp Platz 1, 44789, Bochum, Germany

    Philipp Stude

Authors
  1. Carsten Kohlmeier
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  2. Peter Behrens
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  3. Andreas Böger
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  4. Brinda Ramachandran
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  5. Anthony Caparso
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  6. Dirk Schulze
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  7. Philipp Stude
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  8. Max Heiland
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  9. Alexandre T. Assaf
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Corresponding author

Correspondence to Alexandre T. Assaf.

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Conflict of interest

There was no funding for this study. Authors ATA, CK, AB, PS and PB have been consultants for ATI since 2010 or 2013 and have received speaker honorariums from company ATI and payment for services not related to the conduct of the Pathway CH-1 study. All costs associated with patient care during the Pathway CH-1 trial were reimbursed to all enrolling institutions. MH and DS declare that they have no conflict of interest. AC and BR are members of the company ATI.

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Kohlmeier, C., Behrens, P., Böger, A. et al. Improved surgical procedure using intraoperative navigation for the implantation of the SPG microstimulator in patients with chronic cluster headache. Int J CARS 12, 2119–2128 (2017). https://doi.org/10.1007/s11548-016-1512-2

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  • DOI: https://doi.org/10.1007/s11548-016-1512-2

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