TITLE:
Clinical Impact of Targeting Inaccuracy Due to Distortion of the Leksell Stereotactic Frame
AUTHORS:
Cécile Renier, Nicolas Massager
KEYWORDS:
Targeting, Inaccuracy, Distortion, Frame, Stereotactic
JOURNAL NAME:
Open Journal of Modern Neurosurgery,
Vol.8 No.3,
July
24,
2018
ABSTRACT: Background: Distortion of the Leksell stereotactic frame can occur during surgical and radiosurgical frame-based procedures. The targeting accuracies of surgical procedures such as DBS surgery or frame-based biopsy, or Gamma Knife radiosurgical procedures, are related to the stereotactic frame that is commonly referred to a non-deformable referential system. Objective: To evaluate the clinical impact of frame distortion on accuracy of targeting in various stereotactic procedures. Methods: We studied the influence of increasing levels of distortion of the Leksell frame both on surgical procedures using the stereotactic arch, and on radiosurgical procedures with the Gamma Knife. For surgical procedures we applied the Target Simulator of Elekta to a frame submitted to different levels of frame distortion, and we measured the modifications of accuracy of targeting. For radiosurgical procedures the Leksell frame was applied on an anthropomorphic phantom and modifications of target coordinates were measured by an imaging method using the stereotactic CBCT of the Gamma Knife ICON. Results: For surgical procedures, we found a linear relation between the amount of the frame distortion and the extent of the deviation from the stereotactic target using the stereotactic arch (R2 = 0.99709). The level of bending of the frame is also linearly related to the level of inaccuracy of stereotactic targeting based on acquisition of MRI and CTscan with the Elekta imaging boxes (R2 = 0.96825). The inaccuracy of targeting related to frame bending can be avoided by a systematic control at the end of frame placement and by the use of the CBCT of the Gamma Knife Icon. Conclusion: Distortion of the frame is a significant source of clinical inaccuracy of targeting for stereotactic procedures. Frame bending must be checked after each frame placement and corrected if needed to avoid targeting inaccuracy during stereotactic surgery and radio-surgery procedures.