Frameless and Fiducial-Less Deep Brain Stimulation Surgeries: A Retrospective Comparison of 178 Patients.

BACKGROUND

Deep brain stimulation (DBS) is often performed on awake patients using frame-based neuronavigation. Patients have associated the stereotactic frame with pain. We assessed patient comfort and accuracy of alternative procedures including frameless (FL), frameless fiducial-less (FLFL), and poised cannula (PC) DBS.

METHODS

Medical records were reviewed for 178 patients who underwent DBS between Jan. 2018 and Aug. 2023 at our institution. We transitioned from FL- to FLFL-DBS and then to PC-DBS during this period. Surveys were sent to all patients. Nonparametric tests were used for non-normally distributed data.

RESULTS

Medical records were reviewed for 92 FLFL patients (136 leads) and 93 PC patients (134 leads). The mean radial error was 1.2 ± 0.7 mm (FLFL) vs 1.1 ± 0.5 mm (PC); this difference did not reach significance on Mann-Whitney U testing (p = 0.055, r = 0.14). Cases with > 2.5 mm error were 3.7% (FLFL) and 0.7% (PC). Complication rates for FLFL vs PC were 0.0% vs 2.2% (intracranial events), 3.3% vs 3.2% (hardware removal), and 0.0% vs 0.0% (lead revisions). Of 160 survey respondents (50 FL, 48 FLFL, 62 PC), mean comfort was similar (7.6 ± 0.7, 8.1 ± 0.7, 7.7 ± 0.7; all pairwise Mann-Whitney p > 0.3). Approximately one third of PC patients had no memory of the procedure but still reported being very comfortable.

CONCLUSIONS

FLFL and PC procedures are safe and comfortable alternatives to F- and FL-DBS procedures. Future studies should control for amnestic effects of anesthesia before calculating overall patient comfort.