A Prospective Evaluation of Computer-Assisted Deep Brain Stimulation Trajectory Planning

摘要

Careful planning of deep brain stimulation (DBS) insertion trajectories is key to minimizing risks of surgery-related complications such as hemorrhages, cerebrospinal fluid leakage and loss of function. Recently, some computer-assisted frameworks were proposed and retrospectively validated to demonstrate superior optimization of many surgical constraints in comparison to manual trajectory planning by the neurosurgeon. However, limited data is available on the assessment of whether these computed trajectories prospectively translate to surgical lead insertions. This work presents the clinical integration of a prototype frameless neuronavigation platform and of a new software module, named CAPS (Computer-Assisted Path-planning Software), within the overall DBS surgical workflow. A prospective evaluation on 8 DBS cases reveals that the use of CAPS can influence the surgeon's decision-making. For 7 out of 8 cases, the surgeon performed the lead insertion based on a surgical plan obtained using CAPS and 3 of these plans differed significantly, in lead orientation, from those identified manually using an FDA-approved Medtronic StealthStation system.