Intraoperative 3D Fluoroscopy Accurately Predicts Final Electrode Placement in DBS

Overview

This study evaluated intraoperative three-dimensional fluoroscopy (3DF) against postoperative computed tomography (CT) for determining electrode placement in deep brain stimulation (DBS). Analysis of 124 electrodes in 64 patients demonstrated that 3DF provides accurate localization comparable to CT, supporting its use as a faster, safer, and more accessible intraoperative imaging method.

Background

Deep brain stimulation is an established therapy for movement disorders and other neurological conditions, relying on precise electrode placement within small brain nuclei to optimize therapeutic effects and minimize side effects. Traditional imaging methods for confirming electrode location include two-dimensional fluoroscopy, CT, and MRI, each with limitations related to accuracy, availability, cost, and patient safety. Intraoperative 3DF with a C-arm offers a promising alternative by providing three-dimensional imaging directly in the operating room with lower radiation exposure and reduced logistical challenges compared to CT or MRI.

Data Highlights

Key Findings

• 3DF imaging was performed intraoperatively immediately after electrode implantation, allowing real-time assessment.
• Postoperative CT scans within 48 hours served as the reference standard for electrode tip localization.
• Electrode tip positions were determined in both 3DF and CT images using stereotactic coordinates referenced to the midcommissural point.
• Euclidean distances between electrode tip positions on 3DF and CT were calculated to quantify accuracy.
• 3DF demonstrated high concordance with CT in electrode localization across a large cohort, validating its accuracy.
• 3DF offers advantages including reduced radiation exposure, lower cost, and elimination of patient transport during surgery.

Clinical Implications

Intraoperative 3DF provides a reliable and efficient method to confirm electrode placement during DBS surgery, potentially replacing intraoperative CT in many centers. Its availability in the operating room and lower radiation dose enhance patient safety and reduce operative time and costs. Clinicians can consider adopting 3DF to improve workflow and maintain high accuracy in electrode localization.

Conclusion

This large cohort study supports intraoperative 3DF as an accurate, practical alternative to CT for confirming electrode placement in DBS procedures. Its implementation may streamline surgical workflows while maintaining precise targeting essential for optimal clinical outcomes.

References

1. Author/Source/Year -- Intraoperative 3D fluoroscopy effectively forecasts ultimate electrode placement during deep brain stimulation procedures