PGY-4 Neurosurgical Resident Albany Medical College Albany, New York, United States
Introduction: Deep brain stimulation (DBS) is increasingly being performed using imaging-based techniques with the patient under general anesthesia and direct targeting of the desired anatomic structure. The surgical techniques are evolving over time to maximize efficiency and minimize invasiveness to improve the patient experience and reduce use of MRI resources. Here we describe a modified surgical technique for interventional MRI-guided stereotactic procedures using the ClearPoint platform.
Methods: 161 consecutive cases for DBS lead placement for Parkinson’s disease (43%), essential tremor (45%), dual ET/PD (7%) and dystonia (5%) using the modified ClearPoint technique between 2019 and 2021 were studied. Demographic data, radial error, number of passes and case time were prospectively collected. Medical records were retrospectively reviewed for complications and clinical outcomes.
Results: 146 patients underwent DBS for the placement of 265 total leads. The average radial error was 0.41 mm bilaterally. 98% of leads were placed with a single pass. 82 leads had error < 0.2 mm; 5 leads had error > 1 mm. No patient had to undergo lead revision for lack of clinical response. Pin-to-stylet insertion time, pin-to-frame removal time, and pin-to-room departure time were 2 hrs 2 min, 2 hrs 49 min and 3 hrs 18 min, respectively and were significantly shorter than those obtained with the original ClearPoint technique for our first 150 DBS cases (P < 0.0001). Complications included a 1.2% rate of hardware removal and 1.2% rate of superficial cortical hemorrhage with no long-term neurological sequelae.
Conclusion : The modified ClearPoint technique provides submillimetric accuracy while minimizing invasiveness and MRI surgical time. This procedural workflow can be expanded to other applications, including brain biopsy, laser interstitial thermal therapy, and gene delivery.
