Highlights
- •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.
Abstract
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.
Keywords
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Article info
Publication history
Published online: September 06, 2018
Accepted:
August 13,
2018
Received:
April 18,
2018
Identification
Copyright
© 2018 Elsevier Ltd. All rights reserved.
