{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:35:23Z","timestamp":1787027723581,"version":"build-2736575974"},"reference-count":16,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2020,9,27]],"date-time":"2020-09-27T00:00:00Z","timestamp":1601164800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Brain Sciences"],"abstract":"<jats:p>Object: Deep brain stimulation (DBS) is a very useful procedure for the treatment of idiopathic Parkinson\u2019s disease (PD), essential tremor, and dystonia. The authors evaluated the accuracy of the new method used in their center for the placing of DBS electrodes. Electrodes are placed using the intraoperative O-arm\u2122 (Medtronic)-controlled frameless and fiducial-less system, Nexframe\u2122 (Medtronic). Accuracy was evaluated prospectively in eleven consecutive PD patients (22 electrodes). Methods: Eleven adult patients with PD were implanted using the Nexframe system without fiducials and with the intraoperative O-arm (Medtronic) system and StealthStation\u2122 S8 navigation (Medtronic). The implantation of DBS leads was performed using multiple-cell microelectrode recording, and intraoperative test stimulation to determine thresholds for stimulation-induced adverse effects. The accuracy was checked in three different steps: (1) using the intraoperative O-arm image and its fusion with preoperative planning, (2) using multiple-cell microelectrode recording and counting the number of microelectrodes with the signal of the subthalamic nucleus (STN) and finally, (3) total error was calculated according to a postoperative CT control image fused to preoperative planning. Results: The total error of the procedure was 1.79 mm; the radial error and the vector error were 171 mm and 163 mm. Conclusions: Implantation of DBS electrodes using an O-arm navigated frameless and fiducial-less system is a very useful and technically feasible procedure with excellent patient toleration with experienced Nexframe users. The accuracy of the method was confirmed at all three steps, and it is comparable to other published results.<\/jats:p>","DOI":"10.3390\/brainsci10100683","type":"journal-article","created":{"date-parts":[[2020,9,27]],"date-time":"2020-09-27T22:24:42Z","timestamp":1601245482000},"page":"683","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["O-Arm Navigated Frameless and Fiducial-Less Deep Brain Stimulation"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4907-7960","authenticated-orcid":false,"given":"David","family":"Krahul\u00edk","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Faculty of Medicine and Dentistry, Palack\u00fd University and University Hospital Olomouc, 77900 Olomouc, Czech Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7160-5283","authenticated-orcid":false,"given":"Martin","family":"Nevrl\u00fd","sequence":"additional","affiliation":[{"name":"Department of Neurology, Faculty of Medicine and Dentistry, Palack\u00fd University and University Hospital Olomouc, 77900 Olomouc, Czech Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pavel","family":"Otruba","sequence":"additional","affiliation":[{"name":"Department of Neurology, Faculty of Medicine and Dentistry, Palack\u00fd University and University Hospital Olomouc, 77900 Olomouc, Czech Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Bardo\u0148","sequence":"additional","affiliation":[{"name":"Department of Neurology, Faculty of Medicine and Dentistry, Palack\u00fd University and University Hospital Olomouc, 77900 Olomouc, Czech Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lum\u00edr","family":"Hrab\u00e1lek","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Faculty of Medicine and Dentistry, Palack\u00fd University and University Hospital Olomouc, 77900 Olomouc, Czech Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Pohlodek","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Faculty of Medicine and Dentistry, Palack\u00fd University and University Hospital Olomouc, 77900 Olomouc, Czech Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Petr","family":"Ka\u0148ovsk\u00fd","sequence":"additional","affiliation":[{"name":"Department of Neurology, Faculty of Medicine and Dentistry, Palack\u00fd University and University Hospital Olomouc, 77900 Olomouc, Czech Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Valo\u0161ek","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Faculty of Medicine and Dentistry, Palack\u00fd University and University Hospital Olomouc, 77900 Olomouc, Czech Republic"},{"name":"Department of Neurology, Faculty of Medicine and Dentistry, Palack\u00fd University and University Hospital Olomouc, 77900 Olomouc, Czech Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,9,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1016\/B978-0-444-53497-2.00010-3","article-title":"Clinical outcome of deep brain stimulation for Parkinson\u2019s disease","volume":"Volume 116","author":"Deuschl","year":"2013","journal-title":"Handbook of Clinical Neurology"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1001\/jama.2008.929","article-title":"Bilateral deep brain stimulation vs best medical therapy for patients with advanced parkinson disease: A randomized controlled trial","volume":"301","author":"Weaver","year":"2009","journal-title":"JAMA J. 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