Skull-mounted guidance device for intraoperative CT-guided DBS of neurodegenerative diseases

Abstract

<strong>Background:</strong> Stereotactic surgery, specifically Deep Brain Stimulation (DBS), has been a well-established intervention for treating neurosurgical disorders, including essential tremor and Parkinson's disorders. Intra- operative MRI-guided DBS implantation has become more a prevalent practice, particularly after stereotactic guidance devices for MRI became available. However, we and others have discovered little to no literature contributions regarding the design and validation of tools to facilitate intraoperative CT-scans for DBS implantation. <strong>Objective and Methods:</strong> Our goal is to design and validate a guidance device and software to enable CT- guided DBS; specifically, we validated a skull-mounted guidance device integrated for DBS combined with its 3D Slicer software, and tested a hypothesis that the device provides a tool insertion error (Target Point Error) of less than 3 mm. The measurements were done using a skull phantom, with seven clinically relevant targets distributed at variable depths from two different entry points located in the Frontal and Parietal bones. Further analysis was carried out to understand the reason for increased TPE values at certain targets. <strong>Results:</strong> We found out that our device could produce a TPE of 2.09 ± 0.9 mm for the Frontal bone entry point [<i>p</i> &lt; 0.0001] and 2.52 ± 0.6 mm [<i>p</i> &lt; 0.0016] for the Parietal bone entry point. Additionally, multivariate analysis suggests that depth is the main contributor to larger TPE values when compared to entry points. <strong>Implication:</strong> These results conclude that our iCT-guided device is capable of replacing DBS tools while enjoying the shorter imaging cycles of CT-scanners. The device proposed may also increase opportunities for patients to receive image-guided DBS since CT-scanners are more accessible to the public than MRI is.