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Acta Neurochirurgica

, Volume 154, Issue 11, pp 2069–2074 | Cite as

Robotic implantation of deep brain stimulation leads, assisted by intra-operative, flat-panel CT

  • M. LefrancEmail author
  • D. Le Gars
How I Do it

Abstract

Background

There are two mandatory skills in deep brain stimulation (DBS) neurosurgery: accuracy and control.

Method

Frame-based robotic registration was performed. Prior to insertion into the skull, the guide tube’s position was checked with flat-panel computed tomography (fpCT). After registration against the pre-operative plan, we measured and corrected the robotic arm’s position so that the guide tube with the micro-electrode would follow the planned trajectory exactly. We then used fpCT again to check the DBS lead’s final position.

Conclusion

The combination of intra-operative fpCT with robotised surgery provides an appropriate, user-friendly solution to the key technical challenges in DBS lead implantation.

Keywords

Deep brain stimulation surgery Flat-panel computed tomography Robotised stereotactic assistance 

Notes

Acknowledgements

The authors wish to thank their colleagues involved in DBS surgery: P. Krystkowiak, C. Duru, P. Merle and J.-M. Macron.

Conflicts of interest

None.

Supplementary material

ESM 1

(M4V 76388 kb)

References

  1. 1.
    Benabid A-L, Chabardes S, Mitrofanis J, Pollak P (2009) Deep brain stimulation of the subthalamic nucleus for the treatment of Parkinson’s disease. Lancet Neurol 8:67–81PubMedCrossRefGoogle Scholar
  2. 2.
    Blomstedt P, Sandvik U, Linder J, Fredricks A, Forsgren L, Hariz MI (2011) Deep brain stimulation of the subthalamic nucleus versus the zona incerta in the treatment of essential tremor. Acta Neurochir (Wien) 153:2329–2335CrossRefGoogle Scholar
  3. 3.
    Deuschl G, Schade-Brittinger C, Krack P, Volkmann J, Schäfer H, Bötzel K, Daniels Christine, Deutschländer Angela, Dillmann Ulrich, Eisner Wilhelm, Gruber Doreen, Hamel Wolfgang, Herzog Jan, Hilker Rüdiger, Klebe Stephan, Klob Manja, Koy Jan, Krause Martin, Kupsch Andreas, Lorenz Delia, Stefan Lorenzl H, Mehdorn Maximilian, Moringlane Jean Richard, Oertel Wolfgang, Pinsker Marcus O, Reichmann Heinz, Reub Alexander, Schneider Gerd-Helge, Schnitzler Alfons, Steude Ulrich, Sturm Volker, Timmermann Lars, Tronnier Volker, Trottenberg Thomas, Wojtecki Lars, Wolf Elisabeth, Poewe Werner, Voges Jürgen (2006) A randomized trial of deep-brain stimulation for Parkinson’s disease. N Engl J Med 355:896–908PubMedCrossRefGoogle Scholar
  4. 4.
    Gupta R, Cheung AC, Bartling SH, Lisauskas J, Grasruck M, Leidecker C, Schmidt B, Flohr T, Brady T (2008) Flat-panel volume CT: fundamental principles, technology, and applications. Radiographics 28:2009–2022PubMedCrossRefGoogle Scholar
  5. 5.
    Hamani C, Saint-Cyr JA, Fraser J, Kaplitt M, Lozano AM (2004) The subthalamic nucleus in the context of movement disorders. Brain 127:4–20PubMedCrossRefGoogle Scholar
  6. 6.
    Kall BA (2009) Image reconstruction and fusion. In: Lozano AM, Gildenberg PL, Tasker RL(eds) Textbook of stereotactic and functional neurosurgery. Springer, Berlin Heidelberg, pp 335–343Google Scholar
  7. 7.
    Petersen EA, Holl EM, Martinez-Torres I, Foltynie T, Limousin P, Hariz MI, Zrinzo L (2010) Minimizing brain shift in stereotactic functional neurosurgery. Neurosurgery 67:213–221, discussion 221CrossRefGoogle Scholar
  8. 8.
    Schlaier JR, Habermeyer C, Warnat J, Lange M, Janzen A, Hochreiter A, Proescholdt A, Brawanski A, Fellner C (2011) Discrepancies between the MRI- and the electrophysiologically defined subthalamic nucleus. Acta Neurochir (Wein) 153:2307–2318CrossRefGoogle Scholar
  9. 9.
    Tir M, Devos D, Blond S, Touzet G, Reyns N, Duhamel A, Cottencin O, Dujardin K, Cassim F, Destée A, Defebvre L, Krystkowiak P (2007) Exhaustive, one-year follow-up of subthalamic nucleus deep brain stimulation in a large, single-center cohort of parkinsonian patients. Neurosurgery 61:297–304, discussion 304–305PubMedCrossRefGoogle Scholar
  10. 10.
    Zhang J, Weir V, Fajardo L, Lin J, Hsiung H, Ritenour ER (2009) Dosimetric characterization of a cone-beam O-arm imaging system. J Xray Sci Technol 17:305–317PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  1. 1.Neurosurgery DepartmentAmiens University HospitalAmiens cedex 1France

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