Intraoperative 3D fluoroscopy accurately predicts final electrode position in deep brain stimulation surgery
Purpose In the absence of an intraoperative CT or MRI setup, post-implantation confirmation of electrode position in deep brain stimulation (DBS) requires patient transportation to the radiology unit, prolonging surgery time. This project aims to validate intraoperative 3D fluoroscopy (3DF), a widel...
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| Veröffentlicht in: | Acta neurochirurgica 2024-08, Vol.166 (1), p.328, Article 328 |
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| creator | Neto-Fernandes, Patrícia Chamadoira, Clara Silva, Carolina Pereira, Leila Vaz, Rui Rito, Manuel Ferreira-Pinto, Manuel J. |
| description | Purpose
In the absence of an intraoperative CT or MRI setup, post-implantation confirmation of electrode position in deep brain stimulation (DBS) requires patient transportation to the radiology unit, prolonging surgery time. This project aims to validate intraoperative 3D fluoroscopy (3DF), a widely available tool in Neurosurgical units, as a method to determine final electrode position.
Methods
We performed a retrospective study including 64 patients (124 electrodes) who underwent DBS at our institution. Intraoperative 3DF after electrode implantation and postoperative volumetric CT were acquired. The Euclidean coordinates of the electrode tip displayed in both imaging modalities were determined and inter-method deviations were assessed. Pneumocephalus was quantified and its potential impact in determining the electrode position analyzed. Finally, 3DF and CT-imposed exposure to radiation was compared.
Results
The difference between the electrode tip estimated by 3DF and CT was 0.85 ± 0.03 mm, and not significantly different (
p
= 0.11 for the distance to MCP assessed by both methods), but was, instead, highly correlated (
p
= 0.91;
p
|
| doi_str_mv | 10.1007/s00701-024-06214-8 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_11303432</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>3089688927</sourcerecordid><originalsourceid>FETCH-LOGICAL-c426t-184c24146eef1915b3acb0c07756cdf7ad62fefea42472dfaadb49ef3a11044c3</originalsourceid><addsrcrecordid>eNp9kUtv1TAQhS0EoqXlD7BAlth0Exg_aicrhNoClSqxoWvLccatK984tZNK99_j25Q-WLAZj3Q-H3vmEPKBwWcGoL-UWoA1wGUDijPZtK_IPnSSN7XA62f9HnlXyg0A41qKt2RPdAy0UmqfxPNxzjZNmO0c7pCKU-rjknIqLk1bap1bqoJxS6eMQ3BzoT6MNlKM6OacBqRTKmEOaaRhpAPiRPtsa1vmsFmivVfKkq8wbw_JG29jwfcP5wG5_H72--Rnc_Hrx_nJt4vGSa7mhrXSccmkQvSsY8e9sK4HB1ofKzd4bQfFPXq0kkvNB2_t0MsOvbCMgZROHJCvq--09BscHO5mjGbKYWPz1iQbzEtlDNfmKt0ZxgQIKXh1OHpwyOl2wTKbTSgOY7QjpqUYAW3X6q5r24p--ge9SUuuK1op1bYd15XiK-XqaktG__gbBmaXplnTNDVNc5-m2Vl_fD7H45W_8VVArECp0lhX_PT2f2z_AE9irjo</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>3089688927</pqid></control><display><type>article</type><title>Intraoperative 3D fluoroscopy accurately predicts final electrode position in deep brain stimulation surgery</title><source>MEDLINE</source><source>Springer Nature - Complete Springer Journals</source><creator>Neto-Fernandes, Patrícia ; Chamadoira, Clara ; Silva, Carolina ; Pereira, Leila ; Vaz, Rui ; Rito, Manuel ; Ferreira-Pinto, Manuel J.</creator><creatorcontrib>Neto-Fernandes, Patrícia ; Chamadoira, Clara ; Silva, Carolina ; Pereira, Leila ; Vaz, Rui ; Rito, Manuel ; Ferreira-Pinto, Manuel J.</creatorcontrib><description>Purpose
In the absence of an intraoperative CT or MRI setup, post-implantation confirmation of electrode position in deep brain stimulation (DBS) requires patient transportation to the radiology unit, prolonging surgery time. This project aims to validate intraoperative 3D fluoroscopy (3DF), a widely available tool in Neurosurgical units, as a method to determine final electrode position.
Methods
We performed a retrospective study including 64 patients (124 electrodes) who underwent DBS at our institution. Intraoperative 3DF after electrode implantation and postoperative volumetric CT were acquired. The Euclidean coordinates of the electrode tip displayed in both imaging modalities were determined and inter-method deviations were assessed. Pneumocephalus was quantified and its potential impact in determining the electrode position analyzed. Finally, 3DF and CT-imposed exposure to radiation was compared.
Results
The difference between the electrode tip estimated by 3DF and CT was 0.85 ± 0.03 mm, and not significantly different (
p
= 0.11 for the distance to MCP assessed by both methods), but was, instead, highly correlated (
p
= 0.91;
p
< 0.0001). Even though pneumocephalus was larger in 3DF (6.89 ± 1.76 vs 5.18 ± 1.37 mm
3
in the CT group,
p
< 0.001), it was not correlated with the difference in electrode position measured by both techniques (
p
= 0.17;
p
= 0.06). Radiation exposure from 3DF is significantly lower than CT (0.36 ± 0.03 vs 2.08 ± 0.05 mSv;
p
< 0.0001).
Conclusions
Intraoperative 3DF is comparable to CT in determining the final DBS electrode position. Being a method with fewer radiation exposure, less expensive, faster and that avoids patient transportation outside the operation room, it is a valid tool to replace postoperative CT.</description><identifier>ISSN: 0942-0940</identifier><identifier>ISSN: 0001-6268</identifier><identifier>EISSN: 0942-0940</identifier><identifier>DOI: 10.1007/s00701-024-06214-8</identifier><identifier>PMID: 39107666</identifier><language>eng</language><publisher>Vienna: Springer Vienna</publisher><subject>Adult ; Aged ; Computed tomography ; Deep brain stimulation ; Deep Brain Stimulation - methods ; Electrodes ; Electrodes, Implanted ; Female ; Fluoroscopy ; Fluoroscopy - methods ; Humans ; Imaging, Three-Dimensional - methods ; Interventional Radiology ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Minimally Invasive Surgery ; Neuroimaging ; Neurology ; Neuroradiology ; Neurosurgery ; Radiation ; Radiation measurement ; Retrospective Studies ; Surgical Orthopedics ; Tomography, X-Ray Computed - methods</subject><ispartof>Acta neurochirurgica, 2024-08, Vol.166 (1), p.328, Article 328</ispartof><rights>The Author(s) 2024</rights><rights>2024. The Author(s).</rights><rights>The Author(s) 2024. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>The Author(s) 2024 2024</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c426t-184c24146eef1915b3acb0c07756cdf7ad62fefea42472dfaadb49ef3a11044c3</cites><orcidid>0000-0003-2418-5890</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00701-024-06214-8$$EPDF$$P50$$Gspringer$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00701-024-06214-8$$EHTML$$P50$$Gspringer$$Hfree_for_read</linktohtml><link.rule.ids>230,314,776,780,881,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/39107666$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Neto-Fernandes, Patrícia</creatorcontrib><creatorcontrib>Chamadoira, Clara</creatorcontrib><creatorcontrib>Silva, Carolina</creatorcontrib><creatorcontrib>Pereira, Leila</creatorcontrib><creatorcontrib>Vaz, Rui</creatorcontrib><creatorcontrib>Rito, Manuel</creatorcontrib><creatorcontrib>Ferreira-Pinto, Manuel J.</creatorcontrib><title>Intraoperative 3D fluoroscopy accurately predicts final electrode position in deep brain stimulation surgery</title><title>Acta neurochirurgica</title><addtitle>Acta Neurochir</addtitle><addtitle>Acta Neurochir (Wien)</addtitle><description>Purpose
In the absence of an intraoperative CT or MRI setup, post-implantation confirmation of electrode position in deep brain stimulation (DBS) requires patient transportation to the radiology unit, prolonging surgery time. This project aims to validate intraoperative 3D fluoroscopy (3DF), a widely available tool in Neurosurgical units, as a method to determine final electrode position.
Methods
We performed a retrospective study including 64 patients (124 electrodes) who underwent DBS at our institution. Intraoperative 3DF after electrode implantation and postoperative volumetric CT were acquired. The Euclidean coordinates of the electrode tip displayed in both imaging modalities were determined and inter-method deviations were assessed. Pneumocephalus was quantified and its potential impact in determining the electrode position analyzed. Finally, 3DF and CT-imposed exposure to radiation was compared.
Results
The difference between the electrode tip estimated by 3DF and CT was 0.85 ± 0.03 mm, and not significantly different (
p
= 0.11 for the distance to MCP assessed by both methods), but was, instead, highly correlated (
p
= 0.91;
p
< 0.0001). Even though pneumocephalus was larger in 3DF (6.89 ± 1.76 vs 5.18 ± 1.37 mm
3
in the CT group,
p
< 0.001), it was not correlated with the difference in electrode position measured by both techniques (
p
= 0.17;
p
= 0.06). Radiation exposure from 3DF is significantly lower than CT (0.36 ± 0.03 vs 2.08 ± 0.05 mSv;
p
< 0.0001).
Conclusions
Intraoperative 3DF is comparable to CT in determining the final DBS electrode position. Being a method with fewer radiation exposure, less expensive, faster and that avoids patient transportation outside the operation room, it is a valid tool to replace postoperative CT.</description><subject>Adult</subject><subject>Aged</subject><subject>Computed tomography</subject><subject>Deep brain stimulation</subject><subject>Deep Brain Stimulation - methods</subject><subject>Electrodes</subject><subject>Electrodes, Implanted</subject><subject>Female</subject><subject>Fluoroscopy</subject><subject>Fluoroscopy - methods</subject><subject>Humans</subject><subject>Imaging, Three-Dimensional - methods</subject><subject>Interventional Radiology</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Minimally Invasive Surgery</subject><subject>Neuroimaging</subject><subject>Neurology</subject><subject>Neuroradiology</subject><subject>Neurosurgery</subject><subject>Radiation</subject><subject>Radiation measurement</subject><subject>Retrospective Studies</subject><subject>Surgical Orthopedics</subject><subject>Tomography, X-Ray Computed - methods</subject><issn>0942-0940</issn><issn>0001-6268</issn><issn>0942-0940</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>C6C</sourceid><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp9kUtv1TAQhS0EoqXlD7BAlth0Exg_aicrhNoClSqxoWvLccatK984tZNK99_j25Q-WLAZj3Q-H3vmEPKBwWcGoL-UWoA1wGUDijPZtK_IPnSSN7XA62f9HnlXyg0A41qKt2RPdAy0UmqfxPNxzjZNmO0c7pCKU-rjknIqLk1bap1bqoJxS6eMQ3BzoT6MNlKM6OacBqRTKmEOaaRhpAPiRPtsa1vmsFmivVfKkq8wbw_JG29jwfcP5wG5_H72--Rnc_Hrx_nJt4vGSa7mhrXSccmkQvSsY8e9sK4HB1ofKzd4bQfFPXq0kkvNB2_t0MsOvbCMgZROHJCvq--09BscHO5mjGbKYWPz1iQbzEtlDNfmKt0ZxgQIKXh1OHpwyOl2wTKbTSgOY7QjpqUYAW3X6q5r24p--ge9SUuuK1op1bYd15XiK-XqaktG__gbBmaXplnTNDVNc5-m2Vl_fD7H45W_8VVArECp0lhX_PT2f2z_AE9irjo</recordid><startdate>20240807</startdate><enddate>20240807</enddate><creator>Neto-Fernandes, Patrícia</creator><creator>Chamadoira, Clara</creator><creator>Silva, Carolina</creator><creator>Pereira, Leila</creator><creator>Vaz, Rui</creator><creator>Rito, Manuel</creator><creator>Ferreira-Pinto, Manuel J.</creator><general>Springer Vienna</general><general>Springer Nature B.V</general><scope>C6C</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7TK</scope><scope>7U9</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0003-2418-5890</orcidid></search><sort><creationdate>20240807</creationdate><title>Intraoperative 3D fluoroscopy accurately predicts final electrode position in deep brain stimulation surgery</title><author>Neto-Fernandes, Patrícia ; Chamadoira, Clara ; Silva, Carolina ; Pereira, Leila ; Vaz, Rui ; Rito, Manuel ; Ferreira-Pinto, Manuel J.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c426t-184c24146eef1915b3acb0c07756cdf7ad62fefea42472dfaadb49ef3a11044c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Computed tomography</topic><topic>Deep brain stimulation</topic><topic>Deep Brain Stimulation - methods</topic><topic>Electrodes</topic><topic>Electrodes, Implanted</topic><topic>Female</topic><topic>Fluoroscopy</topic><topic>Fluoroscopy - methods</topic><topic>Humans</topic><topic>Imaging, Three-Dimensional - methods</topic><topic>Interventional Radiology</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Minimally Invasive Surgery</topic><topic>Neuroimaging</topic><topic>Neurology</topic><topic>Neuroradiology</topic><topic>Neurosurgery</topic><topic>Radiation</topic><topic>Radiation measurement</topic><topic>Retrospective Studies</topic><topic>Surgical Orthopedics</topic><topic>Tomography, X-Ray Computed - methods</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Neto-Fernandes, Patrícia</creatorcontrib><creatorcontrib>Chamadoira, Clara</creatorcontrib><creatorcontrib>Silva, Carolina</creatorcontrib><creatorcontrib>Pereira, Leila</creatorcontrib><creatorcontrib>Vaz, Rui</creatorcontrib><creatorcontrib>Rito, Manuel</creatorcontrib><creatorcontrib>Ferreira-Pinto, Manuel J.</creatorcontrib><collection>Springer Nature OA Free Journals</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Neurosciences Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Acta neurochirurgica</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Neto-Fernandes, Patrícia</au><au>Chamadoira, Clara</au><au>Silva, Carolina</au><au>Pereira, Leila</au><au>Vaz, Rui</au><au>Rito, Manuel</au><au>Ferreira-Pinto, Manuel J.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Intraoperative 3D fluoroscopy accurately predicts final electrode position in deep brain stimulation surgery</atitle><jtitle>Acta neurochirurgica</jtitle><stitle>Acta Neurochir</stitle><addtitle>Acta Neurochir (Wien)</addtitle><date>2024-08-07</date><risdate>2024</risdate><volume>166</volume><issue>1</issue><spage>328</spage><pages>328-</pages><artnum>328</artnum><issn>0942-0940</issn><issn>0001-6268</issn><eissn>0942-0940</eissn><abstract>Purpose
In the absence of an intraoperative CT or MRI setup, post-implantation confirmation of electrode position in deep brain stimulation (DBS) requires patient transportation to the radiology unit, prolonging surgery time. This project aims to validate intraoperative 3D fluoroscopy (3DF), a widely available tool in Neurosurgical units, as a method to determine final electrode position.
Methods
We performed a retrospective study including 64 patients (124 electrodes) who underwent DBS at our institution. Intraoperative 3DF after electrode implantation and postoperative volumetric CT were acquired. The Euclidean coordinates of the electrode tip displayed in both imaging modalities were determined and inter-method deviations were assessed. Pneumocephalus was quantified and its potential impact in determining the electrode position analyzed. Finally, 3DF and CT-imposed exposure to radiation was compared.
Results
The difference between the electrode tip estimated by 3DF and CT was 0.85 ± 0.03 mm, and not significantly different (
p
= 0.11 for the distance to MCP assessed by both methods), but was, instead, highly correlated (
p
= 0.91;
p
< 0.0001). Even though pneumocephalus was larger in 3DF (6.89 ± 1.76 vs 5.18 ± 1.37 mm
3
in the CT group,
p
< 0.001), it was not correlated with the difference in electrode position measured by both techniques (
p
= 0.17;
p
= 0.06). Radiation exposure from 3DF is significantly lower than CT (0.36 ± 0.03 vs 2.08 ± 0.05 mSv;
p
< 0.0001).
Conclusions
Intraoperative 3DF is comparable to CT in determining the final DBS electrode position. Being a method with fewer radiation exposure, less expensive, faster and that avoids patient transportation outside the operation room, it is a valid tool to replace postoperative CT.</abstract><cop>Vienna</cop><pub>Springer Vienna</pub><pmid>39107666</pmid><doi>10.1007/s00701-024-06214-8</doi><orcidid>https://orcid.org/0000-0003-2418-5890</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | Acta neurochirurgica, 2024-08, Vol.166 (1), p.328, Article 328 |
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| language | eng |
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| source | MEDLINE; Springer Nature - Complete Springer Journals |
| subjects | Adult Aged Computed tomography Deep brain stimulation Deep Brain Stimulation - methods Electrodes Electrodes, Implanted Female Fluoroscopy Fluoroscopy - methods Humans Imaging, Three-Dimensional - methods Interventional Radiology Male Medicine Medicine & Public Health Middle Aged Minimally Invasive Surgery Neuroimaging Neurology Neuroradiology Neurosurgery Radiation Radiation measurement Retrospective Studies Surgical Orthopedics Tomography, X-Ray Computed - methods |
| title | Intraoperative 3D fluoroscopy accurately predicts final electrode position in deep brain stimulation surgery |
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