Frameless Robot-Assisted Deep Brain Stimulation Surgery: An Initial Experience

Ho, Allen L.; Pendharkar, Arjun V; Brewster, Ryan; Martinez, Derek; Jaffe, Richard A.; Xu, Linda; Miller, Kai J.; Halpern, Casey H.

doi:10.1093/ons/opy395

Cited by 36 publications

(38 citation statements)

References 37 publications

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“…The initial search identified 625 publications, whereas after application of language filter 436 studies remained. A total of 25 full-text papers reporting the use of intraoperative imaging in DBS surgery matched the inclusion criteria [7,8,14,18,19,21,22,24,28,[31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46]. Data reported in this study were included for qualitative and quantitative analysis, totaling 26 papers.…”

Section: Intraoperative Image In Dbs Surgery: Systematic Review Of Thmentioning

confidence: 99%

O-Arm Stereotactic Imaging in Deep Brain Stimulation Surgery Workflow: A Utility and Cost-Effectiveness Analysis

Furlanetti¹,

Hasegawa²,

Oviedova³

et al. 2020

Stereotact Funct Neurosurg

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Introduction: Deep brain stimulation (DBS) surgery is an established treatment for movement disorders. Advances in neuroimaging techniques have resulted in improved targeting accuracy that may improve clinical outcomes. This study aimed to evaluate the safety and feasibility of using the Medtronic O-arm device for the acquisition of intraoperative stereotactic imaging, targeting, and localization of DBS electrodes compared with standard stereotactic MRI or computed tomography (CT). Methods: Patients were recruited prospectively into the study. Routine frame-based stereotactic DBS surgery was performed. Intraoperative imaging was used to facilitate and verify the accurate placement of the intracranial electrodes. The acquisition of coordinates and verification of the position of the electrodes using the O-arm were evaluated and compared with conventional stereotactic MRI or CT. Additionally, a systematic review of the literature on the use of intraoperative imaging in DBS surgery was performed. Results: Eighty patients were included. The indications for DBS surgery were dystonia, Parkinson’s disease, essential tremor, and epilepsy. The globus pallidus internus was the most commonly targeted region (43.7%), followed by the subthalamic nucleus (35%). Stereotactic O-arm imaging reduced the overall surgical time by 68 min, reduced the length of time of acquisition of stereotactic images by 77%, reduced patient exposure to ionizing radiation by 24.2%, significantly reduced operating room (OR) costs per procedure by 31%, and increased the OR and neuroradiology suite availability. Conclusions: The use of the O-arm in DBS surgery workflow significantly reduced the duration of image acquisition, the exposure to ionizing radiation, and costs when compared with standard stereotactic MRI or CT, without reducing accuracy.

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Section: Intraoperative Image In Dbs Surgery: Systematic Review Of Thmentioning

confidence: 99%

O-Arm Stereotactic Imaging in Deep Brain Stimulation Surgery Workflow: A Utility and Cost-Effectiveness Analysis

Furlanetti¹,

Hasegawa²,

Oviedova³

et al. 2020

Stereotact Funct Neurosurg

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“…The patient thus consented to off-label posterior hypothalamic region DBS implantation, and this case study was approved by our institution’s internal review board (IRB#33146). A robot-assisted frameless implantation was performed as described previously (Ho et al, 2019 ). The left posterior hypothalamus was first targeted indirectly ( x , y , z = 2, −5, −3 mm from the mid-commissural point) as described by others (Franzini et al, 2003 ; Sani et al, 2009 ), and confirmed by intra- and post-operative thin-cut CT imaging merged to pre-operative MRI.…”

Section: Methodsmentioning

confidence: 99%

Electrophysiology and Structural Connectivity of the Posterior Hypothalamic Region: Much to Learn From a Rare Indication of Deep Brain Stimulation

Kakusa

Saluja

Dadey

et al. 2020

Front. Hum. Neurosci.

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Cluster headache (CH) is among the most common and debilitating autonomic cephalalgias. We characterize clinical outcomes of deep brain stimulation (DBS) to the posterior hypothalamic region through a novel analysis of the electrophysiological topography and tractography-based structural connectivity. The left posterior hypothalamus was targeted ipsilateral to the refractory CH symptoms. Intraoperatively, field potentials were captured in 1 mm depth increments. Whole-brain probabilistic tractography was conducted to assess the structural connectivity of the estimated volume of activated tissue (VAT) associated with therapeutic response. Stimulation of the posterior hypothalamic region led to the resolution of CH symptoms, and this benefit has persisted for 1.5-years post-surgically. Active contacts were within the posterior hypothalamus and dorsoposterior border of the ventral anterior thalamus (VAp). Delta-(3 Hz) and alpha-band (8 Hz) powers increased and peaked with proximity to the posterior hypothalamus. In the posterior hypothalamus, the delta-band phase was coupled to beta-band amplitude, the latter of which has been shown to increase during CH attacks. Finally, we identified that the VAT encompassing these regions had a high proportion of streamlines of pain processing regions, including the insula, anterior cingulate gyrus, inferior parietal lobe, precentral gyrus, and the brainstem. Our unique case study of posterior hypothalamic region DBS supports durable efficacy and provides a platform using electrophysiological topography and structural connectivity, to improve mechanistic understanding of CH and this promising therapy.

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“…After discussion with and further evaluation of the patient through a multidisciplinary DBS review board, she was deemed a candidate for DBS targeted to the VIM nucleus. Approximately 24 months after her initial left MRgFUS, DBS (Medtronic Activa PC) leads were bilaterally placed without complication using frameless robotic-assisted stereotactic navigation (Ho et al, 2019). Based on the dysarthria previously experienced that was presumed to be due to the relatively medial location of the MRgFUS treatment, DBS leads were placed using target coordinates of -13, -6.5, and 0 mm from the MCP (5.9 mm anterior to PC).…”

Section: Case Descriptionmentioning

confidence: 99%

Case Report on Deep Brain Stimulation Rescue After Suboptimal MR-Guided Focused Ultrasound Thalamotomy for Essential Tremor: A Tractography-Based Investigation

Saluja

Barbosa

Parker

et al. 2020

Front. Hum. Neurosci.

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Essential tremor (ET) is the most prevalent movement disorder in adults, and can often be medically refractory, requiring surgical intervention. MRI-guided focused ultrasound (MRgFUS) is a less invasive procedure that uses ultrasonic waves to induce lesions in the ventralis intermedius nucleus (VIM) to treat refractory ET. As with all procedures for treating ET, optimal targeting during MRgFUS is essential for efficacy and durability. Various studies have reported cases of tremor recurrence following MRgFUS and long-term outcome data is limited to 3-4 years. We present a tractography-based investigation on a case of DBS rescue for medically refractory ET that was treated with MRgFUS that was interrupted due to the development of dysarthria during the procedure. After initial improvement, her hand tremor started to recur within 6 months after treatment, and bilateral DBS was performed targeting the VIM 24 months after MRgFUS. DBS induced long-term tremor control with monopolar stimulation. Diffusion MRI tractography was used to reconstruct the dentatorubrothalamic (DRTT) and corticothalmic (CTT) tracts being modulated by the procedures to understand the variability in efficacy between MRgFUS and DBS in treating ET in our patient. By comparing the MRgFUS lesion and DBS volume of activated tissue (VAT), we found that the MRgFUS lesion was located ventromedially to the VAT, and was less than 10% of the size of the VAT. While the lesion encompassed the same proportion of DRTT streamlines, it encompassed fewer CTT streamlines than the VAT. Our findings indicate the need for further investigation of targeting the CTT when using neuromodulatory procedures to treat refractory ET for more permanent tremor relief.

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Frameless Robot-Assisted Deep Brain Stimulation Surgery: An Initial Experience

Cited by 36 publications

References 37 publications

O-Arm Stereotactic Imaging in Deep Brain Stimulation Surgery Workflow: A Utility and Cost-Effectiveness Analysis

O-Arm Stereotactic Imaging in Deep Brain Stimulation Surgery Workflow: A Utility and Cost-Effectiveness Analysis

Electrophysiology and Structural Connectivity of the Posterior Hypothalamic Region: Much to Learn From a Rare Indication of Deep Brain Stimulation

Case Report on Deep Brain Stimulation Rescue After Suboptimal MR-Guided Focused Ultrasound Thalamotomy for Essential Tremor: A Tractography-Based Investigation

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