Accuracy of Deep Brain Stimulation Lead Placement Using a Cranial Robotic Guidance Platform: A Preliminary Cadaveric Study.

Aim: To measure the deviation rate of a custom 3D-printed Deep Brain Stimulation (DBS) lead holder assisted electrode placements from their intended targets, providing a benchmark for the system?s accuracy and paving the way for its use in standard DBS workflows.

Material and methods: The study was conducted in an experimental lab using a cadaver obtained according to local regulations. Planned electrode trajectories, designed with Medtronic?s DBS surgery planning system, were transferred to the StealthStation Autoguide. A 3D-printed DBS lead holder with integrated navigation fiducials was used to place six electrodes in the targeted brain regions. Pre-operative CT and MRI scans were used for planning, and post-operative imaging confirmed electrode placement. Deviation from planned trajectories was analyzed using Python to assess accuracy.

Results: Following a 30-minute registration and draping process, the median electrode placement time was 22.5 minutes (range: 15-120). The total surgical time for all six electrodes was approximately 5 hours, including imaging, adjustments, and confirmation. The median difference was 1.73 mm (0.03-5.45) on the X-axis, 1.86 mm (0.46-2.74) on the Y-axis, and 1.95 mm (0.73-4.4) on the Z-axis. The median vectorial difference was 2.68 mm (2.3-6.71), while the median trajectory difference was 3.01 mm (1.64-6.63).

Conclusion: Despite 50% of leads having a vectorial difference exceeding 4 mm, most had a trajectory difference of less than 3 mm, which could be attributed to the inability to measure the length of the electrode precisely. These results suggest that with minor adjustments, the StealthStation Autoguide could be a cost-effective alternative to similar systems, though further cadaveric studies are necessary to address potential learning curves and random factors.