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Brain Sci. 2018, 8(5), 90; https://doi.org/10.3390/brainsci8050090

Frameless Stereotaxis for Subthalamic Nucleus Deep Brain Stimulation: An Innovative Method for the Direct Visualization of Electrode Implantation by Intraoperative X-ray Control

1
Stereotactic and Functional Unit, CTO Hospital, ASL Roma 2, Via S. Nemesio 21, 00145 Rome, Italy
2
UOSD Parkinson, Department of Systems Medicine, University of Roma “Tor Vergata”, 00133 Rome, Italy
3
UO Neurology, St. John the Baptist Hospital, ACISMOM, 00148 Roma, Italy
4
Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy
*
Author to whom correspondence should be addressed.
Received: 18 March 2018 / Revised: 11 May 2018 / Accepted: 11 May 2018 / Published: 15 May 2018
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Abstract

The recent introduction of frameless devices has enabled stereotactic neurosurgery to reach a level of accuracy that is comparable to traditional frame-based methodologies. Among frameless devices, the Nexframe appears to be very useful in implanting electrodes into the subthalamic nucleus or other structures for deep brain stimulation in Parkinson’s disease. However, frameless devices, including the Nexframe, limit the possibility of intraoperative visual control of the placement of electrodes in the brain. Utilizing intraoperative O-arm Computed tomography (CT) scan or high-field Magnetic Resonance Imaging (MRI) could overcome this limitation, but their high cost restricts their use. Thus, in this paper we propose an innovation in Nexframe surgical planning that allows the intraoperative use of a C-arm X-ray apparatus to establish: (1) the progression of the electrode guide tube and the electrode in the brain; (2) the accuracy of the electrode trajectory; and (3) the correct attainment of the target. The proposed frameless technique using the Nexframe has been developed and successfully applied in our practice. It was shown to be helpful in overcoming the major issues that are usually encountered when electrodes are placed in the brain with frameless neurosurgery and reduced the risk of having to re-operate on patients to reposition the electrodes. View Full-Text
Keywords: deep brain stimulation; frameless neurosurgery; intraoperative X-ray control; Nexframe; subthalamic nucleus deep brain stimulation; frameless neurosurgery; intraoperative X-ray control; Nexframe; subthalamic nucleus
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Mazzone, P.; Stefani, A.; Viselli, F.; Scarnati, E. Frameless Stereotaxis for Subthalamic Nucleus Deep Brain Stimulation: An Innovative Method for the Direct Visualization of Electrode Implantation by Intraoperative X-ray Control. Brain Sci. 2018, 8, 90.

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