- •There was a statistically significant increase in target error with frameless compared to frame based methods.
- •The size of this effect was small, and likely of questionable clinical significance.
- •Frameless stereotaxy thus appears to deliver adequate accuracy for use in deep brain stimulation.
Deep brain stimulation (DBS) is an effective treatment for movement disorders. It relies on the accurate placement of leads within small nuclei in the basal ganglia. Traditionally, this has been done with great success using frame-based stereotaxy. More recently, frameless systems have been introduced, and several studies have investigated whether they can achieve a similar accuracy. The objective of this meta-analysis was to assess the difference in targeting accuracy between frameless and frame-based systems in deep brain stimulation, using prior studies reporting error in all cardinal directions. We recorded the mean error and standard deviation, and calculated the composite mean difference in error between frame-based and frameless methods using standard difference of means. A total of 76 papers were screened, 25 papers were further assessed, and 5 papers were included in the meta-analysis for a total of 425 DBS electrode placements evaluated. Standard difference of means analysis revealed a statistically significant benefit to frame-based stereotaxy for the x and y coordinates with p = 0.036 and p = 0.0025, respectively. There was no significant difference in the z coordinate. However, the mean differences between frame-based and frameless stereotaxy was small and the composite mean differences were found to be 0.3037 mm, 0.0305 mm, and 0.1630 mm in the x, y and z direction. Our analysis shows that frameless systems represent a reasonable alternative to frame-based methods. Though there was a statistically significant loss of accuracy with frameless methods, the size of this effect was very small and of questionable clinical significance.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Journal of Clinical Neuroscience
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Improvement in Parkinson disease by subthalamic nucleus stimulation based on electrode placement: effects of reimplantation.Arch Neurol. 2008; 65: 612-616
- Intraoperative 3D imaging control during subthalamic Deep Brain Stimulation procedures using O-arm(R) technology: experience in 15 patients.Neurochirurgie. 2014; 60: 276-282
- A randomized trial of deep-brain stimulation for Parkinson’s disease.N Engl J Med. 2006; 355: 896-908
- Clinical outcomes of PD patients having bilateral STN DBS using high-field interventional MR-imaging for lead placement.Clin Neurol Neurosurg. 2013; 115: 708-712
- Frameless deep brain stimulation using intraoperative O-arm technology.Clin Article J Neurosurg. 2011; 115: 301-309
- Electrical stimulation of the globus pallidus internus in patients with primary generalized dystonia: long-term results.J Neurosurg. 2004; 101: 189-194
- Accuracy of stimulating electrode placement in paediatric pallidal deep brain stimulation for primary and secondary dystonia.Acta Neurochir (Wien). 2013; 155: 823-836
- Interventional MRI-guided deep brain stimulation in pediatric dystonia: first experience with the ClearPoint system.J Neurosurg Pediatr. 2014; 14: 400-408
- Long-term suppression of tremor by chronic stimulation of the ventral intermediate thalamic nucleus.Lancet. 1991; 337: 403-406
- Accuracy of deep brain stimulation electrode placement using intraoperative computed tomography without microelectrode recording.J Neurosurg. 2013; 119: 301-306
- Targeting the subthalamic nucleus for deep brain stimulation: technical approach and fusion of pre- and postoperative MR images to define accuracy of lead placement.J Neurol Neurosurg Psychiatry. 2005; 76: 409-414
- Reoperation for suboptimal outcomes after deep brain stimulation surgery.Neurosurg. 2008; 63 (discussion 60-1): 754-760
- Subthalamic nucleus deep brain stimulator placement using high-field interventional magnetic resonance imaging and a skull-mounted aiming device: technique and application accuracy.J Neurosurg. 2010; 112: 479-490
- Comparison of accuracy and precision between frame-based and frameless stereotactic navigation for deep brain stimulation electrode implantation.Stereotact Funct Neurosurg. 2007; 85: 235-242
- Accuracy and precision of targeting using frameless stereotactic system in deep brain stimulator implantation surgery.Neurol India. 2014; 62: 503-509
- Analysis of stereotactic accuracy of the cosman-robert-wells frame and nexframe frameless systems in deep brain stimulation surgery.Stereotact Funct Neurosurg. 2010; 88: 288-295
- Deep brain stimulation for Parkinson's disease using frameless technology.Br J Neurosurg. 2014; 28: 383-386
- Frameless stereotaxy using bone fiducial markers for deep brain stimulation.J Neurosurg. 2005; 103: 404-413
- Analysis of stereotactic accuracy in patients undergoing deep brain stimulation using nexframe and the leksell frame.Stereotact Funct Neurosurg. 2015; 93: 316-325
- Nexframe frameless stereotaxy with multitract microrecording: accuracy evaluated by frame-based stereotactic X-ray.Stereotact Funct Neurosurg. 2010; 88: 163-168
- Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.Int J Surg. 2010; 8: 336-341
- A random effects model for effect sizes.Psychol Bull. 1983; 93: 388-395
- Accuracy of stereotactic electrode placement in deep brain stimulation by intraoperative computed tomography.Parkinsonism Relat Disord. 2008; 14: 595-599
- Intraoperative CT verification of electrode localization in DBS surgery in Parkinson's disease.Interdiscip Neurosurg. 2015; 2: 6-9
- Evaluation of electrode position in deep brain stimulation by image fusion (MRI and CT).Neuroradiology. 2015; 57: 903-908
- Is MRI a reliable tool to locate the electrode after deep brain stimulation surgery? Comparison study of CT and MRI for the localization of electrodes after DBS.Acta Neurochir (Wien). 2010; 152: 2029-2036
- Validation of CT-MRI fusion for intraoperative assessment of stereotactic accuracy in DBS surgery.Mov Disord. 2014; 29: 1788-1795
- Accuracy of postoperative computed tomography and magnetic resonance image fusion for assessing deep brain stimulation electrodes.Neurosurgery. 2011;69:; 207–14 (discussion 14)
- Intraoperative MRI for optimizing electrode placement for deep brain stimulation of the subthalamic nucleus in Parkinson disease.J Neurosurg. 2016; 124: 62-69
- Brain shift during bur hole-based procedures using interventional MRI.J Neurosurg. 2014; 121: 149-160
- Perioperative brain shift and deep brain stimulating electrode deformation analysis: implications for rigid and non-rigid devices.Ann Biomed Eng. 2013; 41: 293-304
- Clinical outcomes using ClearPoint interventional MRI for deep brain stimulation lead placement in Parkinson's disease.J Neurosurg. 2016; 124: 908-916
Published online: September 06, 2018
Accepted: August 13, 2018
Received: April 18, 2018
© 2018 Elsevier Ltd. All rights reserved.