Development of a novel frameless skull-mounted ball-joint guide array for use in image-guided neurosurgery

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Successful convection-enhanced delivery of therapeutic agents to subcortical brain structures requires accurate cannula placement. Stereotactic guiding devices have been developed to accurately target brain nuclei. However, technologies remain limited by a lack of MRI compatibility, or by devices’ size, making them suboptimal for direct gene delivery to brain parenchyma. The goal of this study was to validate the accuracy of a novel frameless skull-mounted ball-joint guide array (BJGA) in targeting the nonhuman primate (NHP) brain.


Fifteen MRI-guided cannula insertions were performed on 9 NHPs, each targeting the putamen. Optimal trajectories were planned on a standard MRI console using 3D multiplanar baseline images. After cannula insertion, the intended trajectory was compared to the final trajectory to assess deviation (euclidean error) of the cannula tip.


The average cannula tip deviation was 1.18 ± 0.60 mm (mean ± SD) as measured by 2 independent reviewers. Topological analysis showed a superior, posterior, and rightward directional bias, and the intra- and interclass correlation coefficients were > 0.85, indicating valid and reliable intra- and interobserver evaluation.


The data demonstrate that the BJGA can be used to reliably target subcortical brain structures by using MRI guidance, with accuracy comparable to current frameless stereotactic systems. The size and versatility of the BJGA, combined with a streamlined workflow, allows for its potential applicability to a variety of intracranial neurosurgical procedures, and for greater flexibility in executing MRI-guided experiments within the NHP brain.

ABBREVIATIONS AC-PC = anterior commissure–posterior commissure; BJGA = ball-joint guide array; CED = convection-enhanced delivery; DICOM = Digital Imaging and Communications in Medicine; iMRI = intraoperative MRI; MPR = multiplanar reconstruction; NHP = nonhuman primate; PEEK = polyetheretherketone; T1W = T1-weighted.

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Contributor Notes

Correspondence Krystof S. Bankiewicz: University of California, San Francisco, CA. WHEN CITING Published online February 15, 2019; DOI: 10.3171/2018.10.JNS182169.

V.S. and A.M. contributed equally to this work.

Disclosures Drs. Bankiewicz and Kells report that they are inventors on a patent (WO2018044933A1) describing the BJGA. Dr. Kells was an employee of Voyager Therapeutics, a publicly traded company, and has direct stock ownership in that company. Drs. Kells and Fiandaca, as current employees of Brain Neurotherapy Bio, Inc., a private company, have direct stock ownership in that company.


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