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

Abstract

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. 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. 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. 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.