To analyze the relationship between trajectory-skull angle and stereoelectroencephalography electrode implantation accuracy in drug-resistant epilepsy patients, aiming to guide clinical electrode placement and enhance surgical precision and safety.
We conducted a retrospective analysis of medical records and surgical characteristics of 32 consecutive patients diagnosed with drug-resistant epilepsy, who underwent stereoelectroencephalography procedures at our center from June 2020 to June 2023. To evaluate the accuracy of electrode implantation, we utilized preoperative and postoperative computed tomography scans fused with SinoPlan software-planned trajectories. Entry radial error and target vector error were assessed as measurements of electrode implantation accuracy.
After adjusting for confounders, we found a significant positive correlation between trajectory-skull angle and entry radial error (β = 0.02, 95% CI: 0.01-0.03, P < 0.001). Likewise, a significant positive correlation existed between trajectory-skull angle and target vector error in all three models (β = 0.03, 95% CI: 0.01-0.04, P < 0.001). Additionally, a U-shaped relationship between trajectory-skull angle and target vector error was identified using smooth curve fitting. This U-shaped pattern persisted in both frame-based and robot-guided stereotactic techniques. According to the two-piecewise linear regression model, the inflection points were 9° in the frame-based group and 16° in the robot-guided group.
This study establishes a significant positive linear correlation between trajectory-skull angle and entry radial error, along with a distinctive U-shaped pattern in the relationship between trajectory-skull angle and target vector error. Our findings suggest that trajectory-skull angles of 9° (frame-based) and 16° (robot-guided) may optimize the accuracy of target vector error.

UNASSIGNED: Spinal cord stimulation (SCS) has been reported to be a promising neuromodulation method for patients with disorders of consciousness (DOC). Our previous studies found that clinical characteristics of patients and SCS stimulation parameters could affect the therapeutic effects of SCS, while surgical-related factors remain unknown. Through the improvement of surgical procedures, most of the SCS electrodes are implanted in the middle, while a small number of electrodes have still deviated.
UNASSIGNED: A total of 137 patients received SCS treatment in our institutions from 1 January 2010 to 31 December 2020. Among them, 27 patients were found with electrode deviation and met the inclusion criteria. Patients were grouped according to whether the electrode deviation angle (EDA) is >30°, respectively. Clinical characteristics of patients and SCS stimulation parameters were compared. Potential related factors and outcomes were evaluated by Chi-square test or two-way repeated measures analysis.
UNASSIGNED: Twenty seven patients receiving cervical SCS treatment were found to have electrode deviation postoperatively. Among them, 12 patients were classified into the more deviation group. No significant difference was found among age, sex, pathogeny, course of DOC, C2-C5 distance, spinal cord to spinal canal ratio at C2 level, and preoperative JFK Coma Recovery Scale-Revised (CRS-R) scores. We found that the electrode direction significantly deviated to the contralateral side in the lateral decubitus position (P = 0.025). The maximum tolerant stimulation intensity in the less deviation group (1.70 ± 0.41) was significantly higher than that in the more deviation group (1.25 ± 0.34) (P = 0.006). Under the strongest stimulation, less unilateral limb tremor (P = 0.049) and paroxysmal sympathetic hyperactivity (PSH) episodes (P = 0.030) were found. EDA had a significant effect on postoperative CRS-R in patients, and patients in the less deviation group had significantly higher postoperative CRS-R (P < 0.01). There was also an interaction effect between EDA and postoperative time. With the prolonged postoperative time, the CRS-R improvement rate of patients with different EDA was different, and the CRS-R improved faster in patients with less EDA (P < 0.05).
UNASSIGNED: Electrode deviation will affect the outcome of patients receiving cervical SCS treatment. The intraoperative surgical position is associated with postoperative electrode deviation direction. The reduction of EDA under 30° can increase maximum tolerant stimulation intensity, reduce complications, and further improve patients\' outcomes.

Objective: To analyze the correlation between intracranial air and electrode displacement after deep brain stimulation. Compared the accuracy of the electrodes on both sides while bilateral intracranial air. Methods: A total of 133 patients with bilateral DBS from February 2017 to February 2019 in neurosurgery department of the General Hospital of Northern Theater Command were included. A total of 266 electrodes were implanted, including 160 sides of subthalamic nucleus, 2 sides of ventromedial nucleus of thalamus and 104 sides of Globus pallidus interior. All patients underwent three-dimensional reconstruction of the head 2 hours after operation and 1 week after operation, which was fused with the preoperative surgical plan.The volume of the intracranial air is obtained by summing up the CT layer-by-layer measurements after surgery. The distance between the implanted electrode and the preoperative target on the X and Y axes in the target plane is measured.Values were expressed as means±SEM,and the t test was performed. Bivariate correlation analysis using linear correlation analysis.P<0.05 was considered statistically significant. Results: There was no statistically significant difference in the fusion error of the electrode between 2 hours and 1 week after surgery on the X-axis. But there was significant difference on the Y-axis. The difference between intracranial air volume and two fusion errors was not linearly correlated on X axis, but linearly positively correlated on Y axis. Conclusion: Intracranial air volume is an important factor affecting the accuracy of DBS surgery. The larger intracranial air volume, the larger the displacement of electrodes on Y axis.
目的： 对脑深部电刺激术（DBS）术后颅内积气（ICA）与电极移位进行相关性分析，并对双侧出现ICA的情况下，两侧电极的精度进行对比研究。 方法： 收集北部战区总医院神经外科2017年2月至2019年2月双侧DBS手术患者133例，共植入电极266侧，其中丘脑底核（STN）160侧，丘脑腹中间核（Vim）2侧，苍白球内侧部（Gpi）104侧。所有病例均于术后2 h和术后1周复查头部CT三维重建（0.625 mm），与术前手术计划融合，测量植入电极与手术计划相对应靶点在靶点平面X轴和Y轴上的偏差距离。ICA体积由术后复查CT逐层测量相加得出。计量资料采用x±s表示，行t检验，双变量关联性分析采用直线相关分析，P<0.05为差异有统计学意义。 结果： 两侧电极在术后1周与术后2 h复查CT与术前计划的融合误差在X轴上[术后2 h误差(0.01~1.75)mm，平均(0.44±0.33)mm；术后1周误差(0~1.17)mm，平均(0.40±0.13)mm]差异无统计学意义，在Y轴上差异具有统计学意义。术后ICA体积与两次融合误差的差值在X轴不具有线性相关关系，在Y轴上具有直线相关关系，且为正相关，差异具有统计学意义。 结论： ICA体积是影响DBS手术精度的重要因素，ICA体积越大，电极在Y轴上的移位越大。.