In gratitude of the loyal support of our members, the CNS is offering complimentary 2021 Annual Meeting registration to all members! Learn more.

  • Accuracy of Novel CT-guided Frameless Stereotactic Drilling and Catheter System in Human Cadavers

    Final Number:

    Eric W. Sankey MD; Eric Butler PA-C; John H. Sampson MD, PhD, MHSc, MBA

    Study Design:
    Laboratory Investigation

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2017 Annual Meeting

    Introduction: Methods to achieve highly accurate placement of intracranial devices using frameless methods are needed. In the present study, we evaluate the accuracy of a CT-guided frameless stereotactic drilling and catheter system.

    Methods: A prospective, single-arm study was conducted using human cadaver heads to evaluate the placement accuracy of a novel, flexible intracranial catheter using frameless stereotaxy and a stabilizing bone-anchor system and drill kit. A total of 20 catheter placements were included for analysis. The primary endpoint of this study was the accuracy of catheter tip location as assessed by the deviation (mm) of the planned compared to the actual tip position on intra-operative computed tomography (CT). Secondary endpoints included: target registration error (TRE), entry and target point error, both pre-and post-drilling. Measurements are reported as mean SD (median, range).

    Results: Based on 20 trajectories, the TRE was 0.46 0.26 (0.50, -1.00-1.00) mm. Two (10%) target point trajectories were negatively impacted by drilling, with variances of 0.6 mm and 0.7 mm, respectively. Intracranial catheter depth was 59.8 9.4 (60.5, 38.0-80.0) mm. Deviation between the planned and the actual entry point on CT was 1.04 0.38 (1.00, 0.40-2.00) mm. Deviation between the planned and actual target point on CT was 1.60 0.98 (1.40, 0.40-4.00) mm. No correlation was observed between the intracranial catheter depth and the target point deviation (accuracy) (Pearson’s coefficient: 0.018), technician experience and accuracy (Pearson’s coefficient: 0.020), or trajectories performed for different cadaver heads (p=0.362).

    Conclusions: Highly accurate catheter placement is achievable using this novel system of a flexible catheter and bone-anchor system, placed via frameless stereotaxy, with an average deviation between the planned and actual target point of 1.60 0.98 (1.40, 0.40-4.00) mm. Large, prospective studies, in live human tissue, are needed to confirm the accuracy exhibited in this study.

    Patient Care: Our results demonstrate that highly accurate intracranial catheter placement is achievable using the frameless stereotactic neuronavigation and bone-anchor based drilling system described in this study, with an average deviation between the planned and actual target point of 1.60 0.98 (1.40, 0.40-4.00) mm. This CED catheter placement technique and system can allow neurosurgeons to reach their desired target without causing injury to nearby anatomic structures, minimizes operative time spent on repeated attempts, and avoids intraoperative complications.

    Learning Objectives: To evaluate the accuracy of intracranial catheter placement using a novel frameless stereotactic drilling and catheter system in human cadaver heads.

    References: 1. Bjartmarz H, Rehncrona S: Comparison of accuracy and precision between frame-based and frameless stereotactic navigation for deep brain stimulation electrode implantation. Stereotact Funct Neurosurg 85:235-242, 2007 2. Cardinale F, Cossu M, Castana L, Casaceli G, Schiariti MP, Miserocchi A, et al: Stereoelectroencephalography: surgical methodology, safety, and stereotactic application accuracy in 500 procedures. Neurosurgery 72:353-366; discussion 366, 2013 3. Chittiboina P, Heiss JD, Lonser RR: Accuracy of direct magnetic resonance imaging-guided placement of drug infusion cannulae. J Neurosurg 122:1173-1179, 2015 4. Dorfer C, Stefanits H, Pataraia E, Wolfsberger S, Feucht M, Baumgartner C, et al: Frameless stereotactic drilling for placement of depth electrodes in refractory epilepsy: operative technique and initial experience. Neurosurgery 10 Suppl 4:582-590; discussion 590-581, 2014 5. Henderson JM, Holloway KL, Gaede SE, Rosenow JM: The application accuracy of a skull-mounted trajectory guide system for image-guided functional neurosurgery. Comput Aided Surg 9:155-160, 2004 6. Nowell M, Rodionov R, Diehl B, Wehner T, Zombori G, Kinghorn J, et al: A novel method for implementation of frameless StereoEEG in epilepsy surgery. Neurosurgery 10 Suppl 4:525-533; discussion 533-524, 2014 7. Pillai P, Sammet S, Ammirati M: Application accuracy of computed tomography-based, image-guided navigation of temporal bone. Neurosurgery 63:326-332; discussion 332-323, 2008 8. Shamir RR, Joskowicz L, Shoshan Y: Fiducial optimization for minimal target registration error in image-guided neurosurgery. IEEE Trans Med Imaging 31:725-737, 2012 9. Shamir RR, Joskowicz L, Spektor S, Shoshan Y: Target and trajectory clinical application accuracy in neuronavigation. Neurosurgery 68:95-101; discussion 101-102, 2011 10. Verburg N, Baayen JC, Idema S, Klitsie MA, Claus S, de Jonge CS, et al: In Vivo Accuracy of a Frameless Stereotactic Drilling Technique for Diagnostic Biopsies and Stereoelectroencephalography Depth Electrodes. World Neurosurg 87:392-398, 2016 11. Widmann G, Eisner W, Kovacs P, Fiegele T, Ortler M, Lang TB, et al: Accuracy and clinical use of a novel aiming device for frameless stereotactic brain biopsy. Minim Invasive Neurosurg 51:361-369, 2008 12. Widmann G, Stoffner R, Sieb M, Bale R: Target registration and target positioning errors in computer-assisted neurosurgery: proposal for a standardized reporting of error assessment. Int J Med Robot 5:355-365, 2009 13. Wood JD, Lonser RR, Gogate N, Morrison PF, Oldfield EH: Convective delivery of macromolecules into the naive and traumatized spinal cords of rats. J Neurosurg 90:115-120, 1999 14. Woodworth GF, McGirt MJ, Samdani A, Garonzik I, Olivi A, Weingart JD: Frameless image-guided stereotactic brain biopsy procedure: diagnostic yield, surgical morbidity, and comparison with the frame-based technique. J Neurosurg 104:233-237, 2006 15. Yin D, Valles FE, Fiandaca MS, Bringas J, Gimenez F, Berger MS, et al: Optimal region of the putamen for image-guided convection-enhanced delivery of therapeutics in human and non-human primates. Neuroimage 54 Suppl 1:S196-203, 2011

We use cookies to improve the performance of our site, to analyze the traffic to our site, and to personalize your experience of the site. You can control cookies through your browser settings. Please find more information on the cookies used on our site. Privacy Policy