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Stereotactic

Calculation of target coordinates for functional stereotactic procedures: comparison of three different techniques.
Slavin KV, Anderson GJ, Burchiel KJ

Objective: To compare three techniques of target coordinate determination for various functional stereotactic procedures.

Methods: Target planning for functional stereotactic operations (thalamotomies, pallidotomies, deep brain stimulators) is based on preoperative MRI with contiguous 3 mm cuts. The first technique involves determination of anatomical landmarks and fiducial markers of the stereotactic frame on a monitor screen of an MRI scanner and calculation of the target point using a series of formulas (M). The second technique uses a Leksell tabletop localizer based on digitized localization of the fiducial markers and anatomical landmarks (T). A third technique is a part of "Stealth" stereotactic navigation software (S). It calculates target coordinates after the surgeon locates position of the midline, AC and PC on the workstation monitor. Final coordinates (F) for the procedure are derived from all three techniques and subsequently adjusted using intraoperative electrical macrostimulation. We also compared number of passes used for targeting in 42 cases where stereotactic navigation software was used with a historical control series of 30 patients who were operated on prior to the software acquisition.

Results: The three sets of calculated target coordinates were compared. We found that the M-T, M-S, S-T, M-F, T-F, and S-F difference was on average 0.70.3 mm in each of three directions, and 1.60.7 mm in absolute distance. Although the average difference was not clinically significant and stayed well below the resolution of the MRI scanner, there were seven cases in which the first (M, n=3) or second (T, n=4) technique had a more than 3 mm discrepancy (> 1 slice thickness) compared with the two other techniques, respectively, indicating a potential error in coordinate determination. In comparison, in only one case the workstation calculated coordinates (S) showed a more than 3 mm difference in the target point compared to the other two methods. Obviously, these differences could potentially result in inappropriate placement of the electrode therefore affecting outcome of the procedure. Finally, the average number of mapping trajectories decreased from 1.8 to 1.3 since stereotactic software became a part of operative planning.

Conclusion: The use of computerized planning software allows an increased precision of target coordinate calculation and improved accuracy of functional stereotactic procedures.

Source: Department of Neurological Surgery


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