Precision of Intraoperative Cone-Beam Computed Tomography in Electrode Placement and Complications in Asleep Deep Brain Stimulation Surgery: A Multidetector Computed Tomography-Verified Comparative Study.

Aim: To examine intraoperative cone-beam computed tomography (iCBCT) accuracy, and the need for postoperative imaging to confirm electrode position, and to assess the complications of deep brain stimulation (DBS) surgery.

Material and methods: Thirty-two movement disorder patients and 69 targets were retrospectively reviewed. All patients had preoperative non-stereotactic 3.0 Tesla magnetic resonance imaging (MRI), preoperative stereotactic multidetector computed tomography (MDCT), post-implantation iCBCT, and postoperative conventional MDCT scans. Stereotactic coordinates of electrode tips were compared between postoperative MDCT and iCBCT. We calculated the absolute and Euclidian differences (ED) between iCBCT and postoperative MDCT coordinates for each electrode. To assess whether intraoperative brain shifting influenced electrode tip localisation, subdural pneumocephalus volume was measured in iCBCT images.

Results: The mean absolute (scalar) differences in x, y, and z coordinates were not significantly different from the absolute precision value of 0 (p > 0.05). The mean ED between the iCBCT electrode tip and the postoperative MDCT electrode tip coordinates was < 1mm (0.55±0.03 mm) and differed significantly from zero (p < 0.0001). There was no correlation between pneumocephalus volume and electrode coordinate deviation.

Conclusion: iCBCT can eliminate the need for routine postoperative studies since it is a safe, effective, and rapid procedure that can be performed at any step of the surgery. It provides reliable and definitive confirmation of correct DBS electrode placement.