Stereotactic computer tomography with a modified Riechert-Mundinger device as the basis for integrated stereotactic neuroradiological investigations

Sturm, Volker; Pastyr, O.; Schlegel, Wolfgang; Scharfenberǵ, H.; Zabel, H.-J.; Netzeband, G.; Schabbert, S.; Berberich, W

doi:10.1007/bf01406197

Cited by 109 publications

(44 citation statements)

References 5 publications

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“…On the day of surgery, the patient’s head was shaved and mounted in a modified RM frame. A stereotactic, contrast-enhanced computed tomography (CT) scan (SOMATOM Definition Flash, Siemens, Erlangen, Germany) was then obtained [21]. Imaging parameters for the CT scan were as follows: matrix size 512 × 512, field of view 300 mm, slice distance 1 mm, voltage 100 kV, current time product 350 mAs and kernel H31s.…”

Section: Methodsmentioning

confidence: 99%

Comparative Study of Robot-Assisted versus Conventional Frame-Based Deep Brain Stimulation Stereotactic Neurosurgery

Neudorfer

Hunsche

Hellmich

et al. 2018

Stereotact Funct Neurosurg

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Background/Aims: Technological advancements had a serious impact on the evolution of robotic systems in stereotactic neurosurgery over the last three decades and may turn robot-assisted stereotactic neurosurgery into a sophisticated alternative to purely mechanical guiding devices. Objectives: To compare robot-assisted and conventional frame-based deep brain stimulation (DBS) surgery with regard to accuracy, precision, reliability, duration of surgery, intraoperative imaging quality, safety and maintenance using a standardized setup. Methods: Retrospective evaluation of 80 consecutive patients was performed who underwent DBS surgery using either a frame-based mechanical stereotactic guiding device (n = 40) or a stereotactic robot (ROSA Brain, MedTech, Montpellier, France) (n = 40). Results: The mean accuracy of robot-assisted and conventional lead implantation was 0.76 mm (SD: 0.37 mm, range: 0.17–1.52 mm) and 1.11 mm (SD: 0.59 mm, range: 0.10–2.90 mm), respectively. We observed a statistically significant difference in accuracy (p < 0.001) when comparing lateral deviations between both modalities. Furthermore, a statistical significance was observed when investigating the proportion of values exceeding 2.00 mm between both groups (p = 0.013). In 8.75% (n = 7) of conventionally implanted leads, lateral deviations were greater than 2.0 mm. With a maximum value of 1.52 mm, this threshold was never reached during robot-guided DBS. The mean duration of DBS surgery could be reduced significantly (p < 0.001) when comparing robot-guided DBS (mean: 325.1 ± 81.6 min) to conventional lead implantation (mean: 394.8 ± 66.6 min). Conclusions: Robot-assisted DBS was shown to be superior to conventional lead implantation with respect to accuracy, precision and operation time. Improved quality control, continuous intraoperative monitoring and less manual adjustment likely contribute to the robotic system’s reliability allowing high accuracy during lead implantation despite limited experience. Hence, robot-assisted lead implantation can be considered an appropriate and reliable alternative to purely mechanical devices.

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Section: Methodsmentioning

confidence: 99%

Comparative Study of Robot-Assisted versus Conventional Frame-Based Deep Brain Stimulation Stereotactic Neurosurgery

Neudorfer

Hunsche

Hellmich

et al. 2018

Stereotact Funct Neurosurg

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“…Implantation of the electrode was performed through an 8-mm burr hole. A modified Riechert-Mundinger aiming bow was used to guide the electrode [9] . After implantation of the first electrode and prior to implantation of the second electrode, intraoperative X-ray imaging and gradient echo T1-weighted MRI with appropriate localizers were performed again to detect and quantify brain shift.…”

Section: Imaging and Surgical Proceduresmentioning

confidence: 99%

Intraoperative X-Ray Detection and MRI-Based Quantification of Brain Shift Effects Subsequent to Implantation of the First Electrode in Bilateral Implantation of Deep Brain Stimulation Electrodes

Hunsche

Sauner²,

Maarouf

et al. 2009

Stereotact Funct Neurosurg

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Objective: After implantation of the first electrode in bilateral deep brain stimulation (DBS) lead implantation, brain shift effects in the target region and along the implantation trajectory of the second electrode are quantified with intraoperative magnetic resonance imaging (MRI). We investigated intraoperative X-ray imaging for its feasibility in indirect detection of brain shift. Methods: In 25 patients who underwent bilateral DBS lead implantation, X-ray and MRI were performed before and after implantation of the first electrode. Two parameters of brain shift were assessed with nonrigid free-form deformation field analysis of the MRI data: global brain shift along the anterior and posterior commissure (AC-PC) line and specific brain shift along the implantation trajectory of the second electrode. Pre- and intraoperative X-ray images were geometrically and intensity corrected for detection of significant signal changes through intracranial air accumulation during implantation of the first electrode. Results: After implantation of the first electrode, brain shift greater than 1 mm (maximum 1.3 mm) was observed at the AC and brain shift greater than 2 mm (maximum 2.5 mm) was observed along the planned implantation trajectory of the second electrode. In 1 patient, the implantation trajectory of the second electrode went through a sulcus after cortical brain shift. In 9 patients, intracranial air volume between 0.1 and 38.5 ml was observed with MRI after implantation of the first electrode. Significant X-ray absorption changes were induced by an intracranial air volume of greater than 8 ml. Conclusion: In bilateral DBS implantation, brain shift effects can cause misallocation of the second electrode with the risk of adverse or no stimulation effects as well as unnecessary cortical damage. A lack of X-ray signal changes caused by intracranial air invasion during DBS lead implantation indicates a lack of clinically relevant brain shift.

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“…The biopsy and implantation were performed with the modified Riechert-Mundinger stereotactic frame. 21 Leibinger software (STP release 2.0 and 3.1) was used for treatment planning (VAX 11/700 computer; Digital Equipment Corp., Maynard, MA/ Workstation VS 3500; Digital Equipment Corp.). Entry points and targets of the catheters were determined with regard to both individual dose distribution and safest path.…”

Section: Methodsmentioning

confidence: 99%

Brachytherapy

Koot

Maarouf

Hulshof

et al. 2000

Cancer

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Stereotactic computer tomography with a modified Riechert-Mundinger device as the basis for integrated stereotactic neuroradiological investigations

Cited by 109 publications

References 5 publications

Comparative Study of Robot-Assisted versus Conventional Frame-Based Deep Brain Stimulation Stereotactic Neurosurgery

Comparative Study of Robot-Assisted versus Conventional Frame-Based Deep Brain Stimulation Stereotactic Neurosurgery

Intraoperative X-Ray Detection and MRI-Based Quantification of Brain Shift Effects Subsequent to Implantation of the First Electrode in Bilateral Implantation of Deep Brain Stimulation Electrodes

Brachytherapy

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