Objective: To compare the accuracy and precision of two different stereotactic frame and microdrive systems (i.e., Cosman-Roberts-Wells (CRW) replaced due to limited customer support and sterilization difficulties by the Leksell frame system) used for implantation of deep brain stimulation (DBS) electrodes.

Background: DBS is an established and effective treatment for patients with Parkinson’s disease (PD). During DBS electrode implantation, stereotactic frame systems facilitate the tracking of the planned trajectory for electrode placement. Whether the stereotactic system used may influence the precision of electrode placement and clinical DBS outcome is unknown.

Method: Pre-operative MRI and post-operative CT data from 63 PD patients (23 implanted using Leksell with STar drive; 40 using CRW with microTargeting™ system), acquired on the same scanner, was used to reconstruct the location of subthalamic nucleus DBS (STN-DBS) electrodes. After electrode reconstruction, 3D-Euclidean distances to the STN were computed in two ways: i) based on the empiric coordinates for surgery planning (stereotactic space), and ii) based on the motor part of the STN (standardized MNI space). The Euclidean distance error [mm] was used to measure accuracy and the error standard deviation (SD) for precision. The association of frame-implanted electrode distances to target and clinical outcomes (UPDRS-III improvement) was evaluated.

Results: Leksell frame led closer electrode positioning to STN (2.89±1.14 mm) in comparison to CRW (3.53±1.69 mm). Leksell placements had higher accuracy (right=1.63; left=1.71) than CRW (right=2.22; left=1.78). Results were highly reproducible in MNI space (Leksell right=1.63, left=1.74; CRW right=2.15, left=2.1). Further, placement precision was higher for Leksell (stereotactic SD right=0.61, left=0.71; MNI SD right=0.56, left=0.82) than CRW (stereotactic SD right=0.94, left=0.96; MNI SD right=0.97, left=1.1). A positive association appeared between distance (r-coefficient right=0.32, left=0.18) and accuracy (right=0.37, left=0.14) with UPDRS-III improvement at the clinically effective stimulation.

Conclusion: The Leksell frame in combination with Star drive seems to be superior in comparison to the CRW frame with microTargeting™. Given that electrode location has a major impact in the modulatory efficacy of DBS, the used frame system may be decisive for the optimal outcomes of STN-DBS therapy in PD.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/comparability-of-frame-systems-for-the-implantation-of-dbs-electrodes-in-parkinsons-disease/