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The accuracy of 3D fluoroscopy (XT) vs computed tomography (CT) registration in deep brain stimulation (DBS) surgery

  • Original Article - Functional Neurosurgery - Movement disorders
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Abstract

Background

Stereotactic registration is the most critical step ensuring accuracy in deep brain stimulation (DBS) surgery. 3D fluoroscopy (XT) is emerging as an alternative to CT. XT has been shown to be safe and effective for intraoperative confirmation of lead position following implantation. However, there is a lack of studies evaluating the suitability of XT to be used for the more crucial step of registration and its capability of being merged to a preoperative MRI. This is the first study comparing accuracy, efficiency, and radiation exposure of XT- vs CT-based stereotactic registration and XT/MRI merging in deep brain stimulation.

Methods

Mean absolute differences and Euclidean distance between planned (adjusted for intraoperative testing) and actual lead trajectories were calculated for accuracy of implantation. The radiation dose from each scan was recorded as the dose length product (DLP). Efficiency was measured as the time between the patient entering the operating room and the initial skin incision. A one-way ANOVA compared these parameters between patients that had either CT- or XT-based registration.

Results

Forty-one patients underwent DBS surgery—25 in the CT group and 16 in the XT group. The mean absolute difference between CT and XT was not statistically significant in the x (p = 0.331), y (p = 0.951), or z (p = 0.807) directions. The Euclidean distance between patient groups did not differ significantly (p = 0.874). The average radiation exposure with XT (220.0 ± 0.1 mGy*cm) was significantly lower than CT (1269.3 ± 112.9 mGy*cm) (p < 0.001). There was no significant difference in registration time between CT (107.8 ± 23.1 min) and XT (106.0 ± 18.2 min) (p = 0.518).

Conclusion

XT-based frame registration was shown to result in similar implantation accuracy and significantly less radiation exposure compared with CT. Our results surprisingly showed no significant difference in registration time, but this may be due to a learning curve effect.

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Funding

We thank the Dalhousie Medical Research Foundation for their generous gift to support this research through the W. Alan Curry Studentship for research in anatomy and surgery.

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Authors and Affiliations

  1. Department of Neurosurgery, Faculty of Medicine, Dalhousie University, Halifax, Infirmary, 1796 Summer Street, Halifax, NS, Canada

    Matthew D. Cooper, Carlos Restrepo, Ron Hill, Murray Hong, Ryan Greene & Lutz M. Weise

  2. Department of Neurosurgery, Goethe University Frankfurt, Frankfurt, Germany

    Lutz M. Weise

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  1. Matthew D. Cooper
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  2. Carlos Restrepo
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  3. Ron Hill
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  4. Murray Hong
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  5. Ryan Greene
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Correspondence to Lutz M. Weise.

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Conflict of interest

Dr. Lutz M. Weise has received speakers honorary and research funds from the Medtronic Canada, Boston Scientific, and Ziehm imaging. The other authors have no other conflicts of interest to disclose.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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This article is part of the Topical Collection on Functional Neurosurgery - Movement disorder

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Cooper, M.D., Restrepo, C., Hill, R. et al. The accuracy of 3D fluoroscopy (XT) vs computed tomography (CT) registration in deep brain stimulation (DBS) surgery. Acta Neurochir 162, 1871–1878 (2020). https://doi.org/10.1007/s00701-020-04322-9

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  • DOI: https://doi.org/10.1007/s00701-020-04322-9

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