Stereotactic and Functional Neurosurgery最新文献

{"title":"Disparities in Access to Deep Brain Stimulation.","authors":"Franziska A Schmidt, Irene Martinez-Torres, Jürgen Germann, Mohammad Mehdi Hajiabadi, Oliver Bichsel, Can Sarica, Andres M Lozano","doi":"10.1159/000548814","DOIUrl":"10.1159/000548814","url":null,"abstract":"<p><strong>Background: </strong>Deep brain stimulation (DBS) is a well-established treatment for several neurological and neuropsychiatric conditions, including movement disorders such as Parkinson's disease, essential tremor, and dystonia, as well as Gilles de la Tourette's syndrome, epilepsy, and obsessive-compulsive disorder.</p><p><strong>Summary: </strong>In recent years, research has expanded to explore the potential of DBS for other indications, including dementia, addiction, disorders of consciousness (e.g., minimally conscious state), and eating disorders. Over the past 3 decades, significant technological advancements have been made in DBS devices, including improvements in electrode design, stimulation parameters, and battery life. However, despite these technological innovations, equitable access to DBS has not progressed at a similar pace. Barriers to access remain a persistent challenge globally, influenced by socioeconomic, geographic, systemic, and policy-related factors.</p><p><strong>Key message: </strong>This review summarizes the current literature on access to DBS, highlighting disparities, challenges, and potential strategies to improve availability and equity in its application.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"101-107"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145281124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neuromodulation in Refractory Bitemporal Lobe Epilepsy in Adults: A Systematic Review and Meta-Analysis.","authors":"Benjamin H Petersen, Zubair Azaz, Keith Yorke, Samuel H Petersen, Abdurrahman F Kharbat, Andrew K Conner","doi":"10.1159/000549636","DOIUrl":"10.1159/000549636","url":null,"abstract":"<p><strong>Introduction: </strong>Bilateral temporal lobe epilepsy represents a subset of patients with medically intractable epilepsy that is particularly difficult to treat. This systematic review and meta-analysis aimed to evaluate the safety and efficacy of three neuromodulation techniques - vagus nerve stimulation (VNS), responsive neurostimulation (RNS), and deep brain stimulation (DBS) - in refractory bilateral temporal lobe epilepsy (BTLE).</p><p><strong>Methods: </strong>In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a thorough electronic literature search using Ovid MEDLINE, Ovid Embase, and PubMed databases. Data from the selected studies were extracted, analyzed, and a quality assessment was performed. Meta-analysis was performed comparing mean seizure reduction rates in VNS, RNS, and DBS.</p><p><strong>Results: </strong>Twenty studies (4 VNS, 7 RNS, 9 DBS) involving 142 BTLE patients were included in the systematic review. Meta-analysis of 12 studies (2 VNS, 5 RNS, 5 DBS) revealed comparable efficacy between VNS (61.69%), RNS (67.51%), and DBS (66.68%), with no statistically significant difference (p = 0.932) between the modalities. All three techniques demonstrated efficacy in seizure reduction. Additionally, complication rates did not significantly differ between VNS, RNS, and DBS.</p><p><strong>Conclusion: </strong>This study provides a comprehensive assessment of existing data regarding the use of neuromodulation in refractory BTLE. VNS, RNS, and DBS demonstrated comparable efficacy, supporting their consideration in treatment planning. Clinical decision-making should weigh factors such as surgical candidacy, patient preferences, comorbidities, and side effect profiles. Further research, including standardized reporting and head-to-head trials, is vital for optimizing treatment protocols and expanding our understanding of neuromodulation's impact on seizure reduction, quality of life, and cognitive outcomes in patients with BTLE.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"268-282"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145782682","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Electrode Tract Oedema in Stereo-Electroencephalography.","authors":"Ming-Sheng Lim, Rayyan AlBaram, Aoife Leonard, Donncha O'Brien, Peter Widdess-Walsh, Ronan Kilbride, Kieron Sweeney","doi":"10.1159/000547449","DOIUrl":"10.1159/000547449","url":null,"abstract":"<p><strong>Introduction: </strong>Stereo-electroencephalography (SEEG) is a safe and effective procedure for the identification of the epileptogenic zone to guide epilepsy surgery. Electrode tract oedema in SEEG is poorly understood. This study reports on its incidence and its clinical and biochemical correlations.</p><p><strong>Methods: </strong>The presence of oedema along the electrode tract on patients after removal of SEEG electrodes was recorded and described. The number of electrodes, duration of implantation, and trend of serum inflammatory markers of patients with and without oedema, and with different extents of oedema were compared.</p><p><strong>Results: </strong>A total of 79.2% of patients and 34.3% of electrodes were associated with oedema. Two radiographic distributions of oedema are described. No differences were found between the number of electrodes, duration of implantation, and the trends of serum inflammatory markers of patients with and without oedema. The trend of the WCC differed between patients who had diffuse compared to localised oedema, but this difference is unlikely to be clinically significant.</p><p><strong>Conclusions: </strong>Radiographic electrode tract oedema is common in SEEG and runs a benign clinical course in our series.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"1-7"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144660244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hippocampal Radiation Exposure and Cognitive Outcomes after Single-Fraction Gamma Knife Radiosurgery for Benign Sellar and Parasellar Lesions: A Prospective Study.","authors":"Cafer Ikbal Gulsever, Altay Sencer, Duygu Dolen Burak, Fatih Koksoy, Dogukan Ozler, Duran Sahin, Deniz Buyukgok, Ilyas Dolas, Pulat Akin Sabanci, Aydin Aydoseli, Yavuz Aras, Levent Demirkol, Rasim Meral, Tugrul Cem Unal","doi":"10.1159/000547709","DOIUrl":"10.1159/000547709","url":null,"abstract":"<p><strong>Introduction: </strong>This study evaluates hippocampal dosimetry and neurocognitive outcomes in patients undergoing Gamma Knife radiosurgery (GKRS) for benign sellar, parasellar, and suprasellar lesions. While hippocampal protection has been well studied in whole-brain radiotherapy, its relevance in stereotactic radiosurgery (SRS) remains underexplored. This study systematically investigates hippocampal radiation dose thresholds and associated neurocognitive outcomes in patients undergoing single-fraction GKRS specifically for benign sellar and parasellar lesions. Although cognitive outcomes after SRS have been previously studied in various contexts, specific hippocampal radiation thresholds and their cognitive impacts in this particular patient population have not been clearly defined.</p><p><strong>Methods: </strong>A prospective analysis was conducted on 41 patients who underwent GKRS, with hippocampal dosimetry assessed using dose-volume parameters (D_min, D_max, D_mean, D40, and D100) following RTOG 0933 contouring protocols. Neurocognitive function was evaluated at baseline and 6 months post-treatment using standardized neuropsychological tests, including assessments of memory, executive function, and emotional well-being. The relationships between hippocampal radiation exposure and cognitive changes were analyzed through correlation and regression models.</p><p><strong>Results: </strong>The mean prescription dose was 12 Gy (range: 10-16 Gy), with a steep dose gradient facilitating hippocampal sparing. Receiver operating characteristic curve analysis identified hippocampal D40 ≥2.5 Gy and D100 ≥2.4 Gy as critical thresholds for neurocognitive decline, and these cutoff values were used in multivariable logistic regression analysis. Significant associations were found between higher hippocampal dose exposure and cognitive decline, particularly in verbal and memory retention domains. A 20% decline in verbal learning (Oktem Verbal Learning Test) was significantly associated with D40 ≥2.5 Gy (OR = 3.04, p = 0.006) and D100 ≥2.4 Gy (OR = 4.3, p = 0.031). Similarly, a 20% decline in memory retention (WMS Immediate Recall) was significantly linked to D40 ≥2.5 Gy (OR = 3.10, p = 0.041) and D100 ≥2.4 Gy (OR = 5.3, p = 0.045). Other factors, including age, gender, education level, and hippocampal volume, were not significantly associated with cognitive decline.</p><p><strong>Conclusion: </strong>This preliminary study suggests that even relatively low-dose hippocampal radiation exposure in GKRS may potentially contribute to memory impairment. These initial findings provide insights into possible hippocampal dose thresholds specifically for single-fraction GKRS in benign lesions. However, larger prospective studies with longer follow-up periods are essential to validate these observations before recommending routine incorporation of hippocampal-sparing strategies into GKRS planning.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"19-35"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144790120","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stereotactic Focused Ultrasound Mesencephalotomy for the Treatment of Head and Neck Cancer Pain.","authors":"W Jeffrey Elias, Chang-Chia Liu, Divine Nwafor, Patrick H Finan, Mark Quigg, Shayan Moosa","doi":"10.1159/000547639","DOIUrl":"10.1159/000547639","url":null,"abstract":"<p><strong>Introduction: </strong>Historically, stereotactic mesencephalotomy was developed as a \"supraspinal\" cordotomy for cancer and neuropathic pain. Early experiences relieved pain, but the procedure was never widely adopted because of the associated morbidity with midbrain lesioning. Contemporary image-guided lesioning could make this a feasible procedure for cancer patients suffering with pain.</p><p><strong>Methods: </strong>A single-center, nonrandomized, early phase trial was designed to treat patients with severe, refractory pain from head and neck cancer with unilateral MRI-guided focused ultrasound mesencephalotomy. Safety was the primary outcome, but measures of efficacy were assessed with pain intensity and more functional components of pain.</p><p><strong>Results: </strong>A discrete midbrain lesion was created for the 5 patients. All patients with advanced cancer had limited survival of less than 3 months, but they tolerated the procedure and experienced pain relief to different degrees. Two had profound pain relief, one was partial, and two others were very brief. One patient was transiently obtunded and other procedural morbidities were mild: numbness (3), oculomotor disturbance (1), and agitation (1). Electroencephalography, somatosensory evoked potentials, and quantitative sensory testing were obtained when possible.</p><p><strong>Conclusion: </strong>Stereotactic focused ultrasound mesencephalotomy is a modern, image-guided, lesioning technique that may be effective for cancer pain.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"8-18"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12406951/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144733346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feasibility of Basal Ganglia Microelectrode Recordings under General Anesthesia with Combined Nitrous Oxide and Sevoflurane: A Retrospective Single-Center Experience.","authors":"Ahmad Alhourani, Igor Abramovich, Jacob H Marks, Joshua V Porter, Chanhung Lee, Doris D Wang","doi":"10.1159/000549783","DOIUrl":"10.1159/000549783","url":null,"abstract":"<p><strong>Introduction: </strong>Deep brain stimulation (DBS) is an established treatment for Parkinson's disease (PD). The traditional method for accurate implantation is awake microelectrode recordings (MERs) to map out the borders of the target nucleus. However, a significant portion of patients are unable to tolerate awake surgical procedures. Asleep MER techniques under different general anesthesia regimens have been described with variable effects on recording quality and required a lower inhaled sevoflurane level to obtain single unit recordings. Hence, a reliable method for asleep MER mapping is needed without compromising patient safety and comfort. We aimed to assess the feasibility and quality of basal ganglia MER under general anesthesia using inhalational agents including adding nitrous oxide as an adjunct to sevoflurane (N₂O-GA).</p><p><strong>Methods: </strong>This study retrospectively examined PD patients undergoing DBS implantation targeting either the subthalamic nucleus (STN) or the globus pallidus internus (GPi) at a single center. Anesthetic data on end-tidal (ET) sevoflurane and nitrous oxide, with the derived minimum alveolar concentration (MAC) were captured during the time of MER mapping. We evaluated the feasibility of identifying target nuclei borders, the quality of neuronal unit isolation, and the physiological dimensions of the targeted nuclei. We calculated the concordance between the nuclei sizes based on MER mapping and imaging. We also reported the firing characteristics of isolated units.</p><p><strong>Results: </strong>We identified 18 patients (34 nuclei) who underwent STN (n = 11) and GPi (n = 7) DBS implantation. Background activity changes were reliable in all patients for border identification. The length of the tract identified by MER was highly concordant with the anatomical tract length identified by postoperative imaging (concordance correlation coefficient: 0.84, p < 0.001). Firing in both nuclei showed higher bursting rates. Pallidal cells showed typical firing patterns with \"pauser\" cells in the GPe and continuous firing in the GPi. No complications were observed during follow-up. A total of 16 patients had MER data available for offline analysis. We identified 516 units (single/multi) across MER 28 tracts (STN = 284, GP = 232). In the 14 patients received the N₂O-GA, anesthetic depth was maintained at 0.97 ± 0.06 MAC, compared to 0.525 ± 0.04 MAC in the sevoflurane-only cases.</p><p><strong>Conclusion: </strong>MER under N₂O-GA is feasible for DBS target nuclei identification for both STN and GPi and offers a safe and accurate surgical approach for PD patients unable to tolerate awake mapping.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"204-212"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145678872","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative Treatment with Bisphosphonates Does Not Change the Thermal Response of Focused Ultrasound Thalamotomy.","authors":"Matthew C Henn, Nemanja Useinovic, James Cahill, Helen Shi, Beck Shafie, Haley Smith, Molly Joyce, Tim Valuev, Christian G Lopez-Ramos, Ahmed M Raslan, Daniel R Cleary","doi":"10.1159/000549833","DOIUrl":"10.1159/000549833","url":null,"abstract":"<p><strong>Introduction: </strong>Skull density ratio (SDR) is an important criterion for predicting efficacy of high-intensity focused ultrasound (HIFU) thalamotomy for essential tremor and tremor-dependent Parkinson's disease. Bisphosphonates are known to increase bone density and are postulated to raise SDR and improve HIFU energy transmission efficiency. However, the impact of bisphosphonate pre-treatment on HIFU outcomes has not been investigated.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on the sonication parameters of patients with SDR <0.45 who were pre-treated off-label with bisphosphonates prior to HIFU. For comparison, the sonication parameters were also collected for patients with SDR <0.45 not pre-treated with bisphosphonates, patients with mid-range SDR (0.45-0.49), and patients with high SDR (0.5-0.55). All patients underwent HIFU thalamotomy between March 2022 and December 2024.</p><p><strong>Results: </strong>The bisphosphonate pre-treatment group (28 patients) and the low-SDR untreated group (29 patients) both had mean SDRs of 0.41. Respectively, the bisphosphonate-treated and low-SDR untreated group had mean final sonication energy of 23 kJ versus 26 kJ, final sonication duration of 27.1 versus 28.6 s, mean maximum temperature of 52.8°C versus 53.2°C, and average of 5.6 versus 4.9 sonications per treatment (p > 0.05 for each comparison). No significant differences between the two low-SDR groups were found for the thermal efficiency of sonication. Compared to the bisphosphonate-treated low-SDR group, the mid- and high-SDR groups exhibited significantly decreased sonication energy (p < 0.0001), final sonication duration (p < 0.0001), and higher final sonication max temperature (p < 0.01). Across all patients, a negative correlation was observed between SDR and final sonication energy (p < 0.0001, r = -0.48) and a positive correlation was observed between SDR and last sonication temperature (p < 0.005, r = 0.27), although in the low-SDR cohort, a correlation was not observed. No clinically significant differences were found in demographics, self-reported tremor improvement, or incidence of side effects.</p><p><strong>Conclusion: </strong>No significant differences were found in sonication response parameters between the bisphosphonate-treated and untreated low-SDR groups, whereas mid- and high-SDR groups had significantly reduced sonication energy and time to produce greater heat. These findings show that while bisphosphonates are an established way of raising bone density in osteoporosis, pre-treatment with bisphosphonates does not shift the sonication response from that of a low SDR to a mid-range SDR. Additionally, other factors besides just skull density likely determine the thermal response to sonication.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"231-241"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145688144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anatomical Group-Level Studies of the Volume of Tissue Activated by Deep Brain Stimulation in Parkinson's Disease: A Model for Targeting?","authors":"Yarit Wiggerts, Martijn Beudel, Maarten Bot, Pepijn van den Munckhof, Rob M A de Bie, Rick Schuurman","doi":"10.1159/000549455","DOIUrl":"10.1159/000549455","url":null,"abstract":"<p><p><p>Introduction: Parkinson's disease (PD) is a neurodegenerative disorder for which deep brain stimulation (DBS) of the subthalamic nucleus (STN) is an established treatment. Despite standardized programming, some patients seem to respond very well to DBS (optimal responders), while others seem to react poorly (poor responders). The objective was to compare the area of tissue activated between optimal and poor responders and determine whether there is a potential optimal stimulation area.</p><p><strong>Methods: </strong>For 338 PD patients with STN-DBS, four outcome categories on the Movement Disorders Society Unified Parkinson Disease Rating Scale (MDS-UPDRS) motor part were assessed: hemibody, rigidity, bradykinesia, and tremor score for left and right separately. For each outcome category, patients were divided into one of three responder groups, based on their percentage hemibody improvement (optimal responders, >70% improvement; responders, 30-70% improvement; poor responders, <30% improvement). For each of the resulting 12 groups, volumes of tissue activated (VTA) were modeled for every individual electrode based on the stimulation parameters during follow-up assessment. To enable the responder groups comparison, all VTAs were aggregated into a so-called heatmap in normalized space. As we were mainly interested in the difference in VTA location for the optimal and poor responders, only these group heatmaps were visually assessed in reference to the STN. For quantitative sub-analyses, the amount of current applied and spread of electrode location was compared.</p><p><strong>Results: </strong>Considerable overlap between heatmaps of optimal and poor responders within the dorsolateral region of the STN was seen. The amount of current applied and spread of electrode location did not differ.</p><p><strong>Conclusions: </strong>This study comparing anatomical group-level studies of VTAs of optimal responders with poor responders for STN-DBS in PD did not find an area of optimal stimulation to reduce variability in DBS outcome. However, the heatmap of optimal responders can facilitate easier DBS targeting. To reduce variability in DBS outcome, focus could shift more toward patient-specific anatomy and connectivity levels in order to determine the individual optimal subthalamic area for programming. </p>.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"155-165"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12707916/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145459617","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Staged Bilateral MR-Guided Focused-Ultrasound Pallidothalamic Tractotomy for Parkinson's Disease Cleared by the FDA: Caveat Emptor!","authors":"Sami Barrit, Romain Carron, Marwan Hariz","doi":"10.1159/000548824","DOIUrl":"10.1159/000548824","url":null,"abstract":"","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"147-149"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145438785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stereotactic Accuracy and Technique Utilizing the SmartFrame OR Platform with Stereotactic Navigation and Cone Beam CT Image-Guided Forward Projection.","authors":"Kishore Balasubramanian, Helen Shi, Tressie M Stephens, Matthan Tharakan, Andrew K Conner","doi":"10.1159/000549337","DOIUrl":"10.1159/000549337","url":null,"abstract":"<p><strong>Introduction: </strong>Asleep deep brain stimulation (DBS) is limited by its reliance on interventional/intraoperative MRI in many cases. A frameless stereotaxy system can be used in combination with optical navigation for initial coarse alignment, followed by a navigational iCT scan to enable asleep DBS in standard operating rooms, aiming to improve accessibility and precision.</p><p><strong>Methods: </strong>This retrospective study analyzed 32 patients (33 procedures) undergoing DBS electrode placement using the SmartFrame OR™ system (ClearPoint Neuro Inc., San Diego, CA). Radial targeting error and operative duration were assessed. Surgical workflows combined O-arm imaging (Medtronic Inc, Minneapolis, MN) and StealthStation™ S8 neuronavigation (Medtronic Inc, Minneapolis, MN, USA). Targets included the ventral intermediate nucleus (VIM), subthalamic nucleus (STN), globus pallidus internus, hippocampus, and thalamic nuclei.</p><p><strong>Results: </strong>Median radial targeting error was 0.40 mm (range: 0-1.6 mm), with bilateral procedures showing marginally lower errors (0.35 mm vs. 0.50 mm unilateral). The VIM exhibited the highest precision (0.35 mm), while STN targeting had slightly higher error (0.53 mm). Median operative time was 189 min (140-275 min), with bilateral procedures requiring longer durations (190 vs. 155 min, p = 0.001). No major complications occurred, and no revisions were needed.</p><p><strong>Conclusion: </strong>The ClearPoint SmartFrame OR™ system achieved submillimeter accuracy and operational efficiency comparable to MRI-guided platforms while eliminating MRI dependency. Its integration with O-arm and Stealth Navigation enhances accessibility, reduces costs, and maintains safety, positioning it as a scalable solution for asleep DBS in standard neurosurgical settings.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"194-203"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145709540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}