Turkish Neurosurgery
Stereotactic Frame-Based Electrode Insertion: The Accuracy of Increasingly Oblique Insertion Angles
Zachary Gilbert1, Austin Tang1, Terrance Peng1, Li Ding1, Emiliano Tabarsi1, Jonathan Cavaleri1, Andrea Leonor1, Roberto Martin Del Campo-Vera1, Arthur Shao1, Ryan Chung1, Shivani Sundaram1, Alexandra Kammen1, Angad Gogia1, Charles Liu1, Spencer Kellis1, Brian Lee1
1Keck School of Medicine of USC, Neurological Surgery, Los Angeles, CA,
2Keck School of Medicine of USC, USC Neurorestoration Center, Los Angeles, CA,
DOI: 10.5137/1019-5149.JTN.42185-22.2

Aim:Stereotactic placement of intracranial electrodes is a neurosurgical technique for targeting deep brain structures in the treatment of movement disorders and epilepsy. Electrode trajectories are planned to avoid vascular structures and minimize neural injury using three angular coordinates and insertion depth. Proper drill hole placement is critical to accurate electrode insertion. This study investigates the relationship between planned drill approach angle and angular deviation of the electrode tip.Material and Methods:Stereotactic electrode implantation was performed in 13 patients with drug resistant epilepsy. A total of 136 electrodes were included in our analysis. Stereotactic targets were planned on pre-operative magnetic resonance imaging (MRI) scans and implantation was carried out using a Cosman-Roberts-Wells stereotactic frame with the Ad-Tech drill guide and electrodes. Post implant electrode angles in the axial, coronal, and sagittal planes were determined from post-operative computerized tomography (CT) scans and compared with planned angles using Bland-Altman plots and linear regression. Results:Qualitative assessment of correlation plots between planned and actual angles demonstrated a linear relationship for axial, coronal, and sagittal planes, with no overt angular deflection for any magnitude of the planned angle. Conclusion:The accuracy of CRW frame-based electrode placement using the Ad-Tech drill guide and electrodes is not significantly affected by the magnitude of the planning angle. Based on our results, oblique electrode insertion is a safe and accurate procedure.

Corresponding author : Zachary Gilbert