Objective: To determine the accuracy of intraoperative CT (iCT) in localizing deep brain stimulation (DBS) electrodes by comparing this modality with postoperative magnetic resonance imaging (MRI).

Background: Optimal lead placement is a critical factor for outcome of DBS procedures and preferably confirmed during surgery. Intraoperative CT offers 3-dimensional (3D) verification of both microelectrode and DBS lead location during DBS surgery. However, accurate electrode representation on iCT has not been extensively studied.

Methods: DBS surgery was performed using the Leksell stereotactic G frame. Stereotactic coordinates of the most ventral electrode contact of 52 DBS leads were determined on both iCT and postoperative MRI and compared with intended final target coordinates. The resulting absolute differences in X (medial-lateral), Y (anterior-posterior) and Z (dorsal-ventral) coordinates (ΔX, ΔY and ΔZ) for both modalities were then used to calculate the Euclidian distance, which describes the accuracy in 3D space.

Results: Euclidian distances were 2.7 ± 1.1 mm and 2.5 ± 1.2 mm for MRI and iCT, respectively (P=0.2). For iCT (mean ± SD) absolute differences for X, Y and Z were 1.3 ± 1.0 mm, 1.3 ± 1.1 mm, 1.3 ± 0.9 mm, corresponding numbers for MRI were 1.3 ± 1.1 mm, 1.1 ± 1.0 mm, 1.7 ± 1.0 mm. On iCT a more dorsal lead position was seen (P=0.01).

Conclusions: Postoperative MRI and iCT show equivalent DBS lead representation. Intraoperative localization of both microelectrode and DBS lead in stereotactic space enables direct adjustments intra-operatively. Verification of lead placement with postoperative MRI, considered to be the gold standard, is unnecessary.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/accuracy-of-intraoperative-ct-during-dbs-procedures-comparison-with-postoperative-mri/