![]() ![]() The patient is positioned on the operating table integrated to the Airo system with the frame fixed on the Mayfield head holder. Once stereotactic target coordinates and ring and arc frame values are obtained, the surgical procedure begins. ![]() To avoid sulcal vessels and ventricles for each side of implantation, the trajectories are computer-based determined. Tissue-based automatic segmentation allows to define the exact anatomy of each patient for precise individual-based targeting, overcoming the limitations of the more traditional approach of indirect targeting based on atlas coordinates. The BrainLab creates automatically based on each patient specific neuroanatomy 3D objects that include critical structures, the region of interest, and the basal ganglia territory. The choice of the target is based on direct viewing on MRI. MRI and CT scan images are transferred to the BrainLab planning station and fused together. On the day of surgery after positioning the Cosman-Roberts-Wells stereotactic frame, a stereotactic CT scan is acquired. One day before surgery, we perform a brain magnetic resonance imaging (MRI 1.5 Tesla), which consists in a volumetric gadolinium-enhanced T1-weighted sequence and axial T2-weighted or proton-density (PD) images, with a 2 mm slice thickness. To the best of our knowledge, this is the first report of intraoperative Airo use in DBS. In this paper, we present the specific workflow on the use of intraoperative CT-Airo system and differences compared to O-arm. Intraoperative CT has the advantage in improving surgical precision and reducing for the patient and the surgical equip discomfort due to the patient’s transfer from the operating room to the radiological unit reducing the time of control or time of reposition in cases of lead misplacement.Īt present, two intraoperative CT scan systems are available: O-arm (Medtronic) and Airo CT (BrainLab), while the experience with O-arm is well consolidated (26 papers published so far), Airo CT is becoming increasingly more used in surgery. To verify lead positioning in most centers, radiological evaluation is done, using lateral and anteroposterior X-ray, while intraoperative CT scan or MRI imaging is present in few centers. ![]() Deep brain stimulation (DBS) efficacy depends foremost on two main factors, (a) patient selection and (b) correct lead positioning the former depends on the experience of the multidisciplinary DBS equip, while the latter on the experience of the neurosurgeon. ![]()
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