In vitro assessment and comparison of a novel electromagnetic tracking system for stereotactic DBS surgery

Abstract

Real-time guidance for the implantation of deep-brain-stimulation (DBS) electrodes in the context of stereotactic neurosurgery is essential but currently unavailable. Electromagnetic tracking (EMT) systems offer high-accuracy localization of tools in restricted volumes but face compatibility issues with stereotactic procedures due to electromagnetic distortions. This paper aims to evaluate and compare the localization performance (position and orientation) of a novel EMT system, the ManaDBS, specifically designed for stereotactic surgical environments, against the NDI Aurora, a commercially available EMT system. Two studies were conducted to assess the suitability of each EMT system for stereotactic DBS surgery. The first study evaluated performance accuracy within the measurement volume in the presence of two different stereotactic systems (Frame G and Vantage system, Elekta). The second study simulated a DBS surgical theater, performing implantation procedures with each EMT system and evaluating the position accuracy of the EMT sensor. The localization errors of Aurora (0.66 mm and 0.89°) were lower to those of ManaDBS (1.57 mm and 1.01°). However, in the presence of a stereotactic system, Aurora exhibited notable degradation (2.34 mm and 1.03°), whereas ManaDBS remained unaffected. This pattern persisted during simulated implantation in a DBS surgical environment, where nonlinear trajectories with significant error fluctuations along the implantation path were observed with Aurora system. The significant electromagnetic-field distortions render the Aurora system incompatible for stereotactic DBS surgery. However, the ManaDBS system exhibited no impact from these distortions, suggesting its potential suitability for DBS surgery and other potential applications in stereotactic neurosurgery.