Intraoperative 3D fluoroscopy accurately predicts correct electrode location in deep brain stimulation surgery

• Autor(a) principal: Fernandes, Patrícia Adriana Neto
• Data de Publicação: 2023
• Tipo de documento: Dissertação
• Idioma: eng
• Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
• Texto Completo: http://hdl.handle.net/10400.6/13480
• topic: Estereotaxia; Estimulação Cerebral Profunda; Fluoroscopia 3d Intraoperatória; Localização do Elétrodo; Neurocirurgia Funcional; Domínio/Área Científica::Ciências Médicas::Ciências da Saúde::Medicina

Background: The effectiveness of deep brain stimulation (DBS) surgery critically depends on accurate electrode position. An anatomical post-implantation confirmation of the electrode position is required to exclude unwanted shifts. This project aims to validate the intraoperative 3D fluoroscopy (3DF) as a tool to determine the final electrode position. Since it is a faster, cheaper, low-radiation method, that is readily available in the OR, it may replace the standard post operative CT, if similar imaging acuity is verified. Methods: This is a retrospective study that includes 64 patients (124 electrode) who underwent DBS surgery, from May 2019 to January 2022, at Centro Hospitalar Universitário de São João. All patients underwent intraoperative 3DF after implantation of the definitive electrodes and a CT scan within 48 hours after surgery. In order to compare the accuracy of both methods, the images were fused in a stereotaxic planning station and the electrode tip position was determined, as well as its distance to the midcommissural point in both imaging modalities. Finally, intracranial air (pneumocephalus) volume was also quantified and its potential impact in determining the electrode position analyzed. Euclidean coordinates of the electrode tip were used to calculate the deviation of the electrodes using the Pythagorean Theorem applied to space. Results: The difference between the electrode position estimated by 3DF and CT was 0,85 mm (± SEM 0,03), which is inferior to the CT resolution (1mm). The distance to the midcommissural point measured in both methodologies was not significantly different (13,00 ± 0,16 mm in F3D and 13,06 ± 0,16 in CT), but was, instead, highly correlated. Despite the fact that pneumocephalus was larger in the 3DF images (6,89 ± 1,76 vs 5,18 ± 1,37 cm3 in the CT group), it was not correlated with the difference in electrode position measured by both techniques. Conclusions: 3DF accurately predicts final lead position in DBS surgery. Being a method with fewer radiation, less expensive, faster, and that doesn’t require the patient to be transported outside the OR, it could replace CT as a tool to determine final electrode position.