Use of a novel ball-joint guide array for magnetic resonance imaging–guided cannula placement and convective delivery: technical note

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  • 1 Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio; and
  • 2 Department of Neurological Surgery, Centrum Medyczne Kształcenia Podyplomowego, Brodno Hospital, Warsaw, Poland
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OBJECTIVE

The objective of this study was to assess the feasibility, accuracy, effectiveness, and safety of an MRI-compatible frameless stereotactic ball-joint guide array (BJGA) as a platform for cannula placement and convection-enhanced delivery (CED).

METHODS

The authors analyzed the clinical and imaging data from consecutive patients with aromatic l-amino acid decarboxylase (AADC) deficiency who underwent infusion of adeno-associated virus (AAV) containing the AADC gene (AAV2-AADC).

RESULTS

Eleven patients (7 females, 4 males) underwent bilateral MRI-guided BJGA cannula placement and CED of AAV2-AADC (22 brainstem infusions). The mean age at infusion was 10.5 ± 5.2 years (range 4–19 years). MRI allowed for accurate real-time planning, confirmed precise cannula placement after single-pass placement, and permitted on-the-fly adjustment. Overall, the mean bilateral depth to the target was 137.0 ± 5.2 mm (range 124.0–145.5 mm). The mean bilateral depth error was 0.9 ± 0.7 mm (range 0–2.2 mm), and the bilateral radial error was 0.9 ± 0.6 mm (range 0.1–2.3 mm). The bilateral absolute tip error was 1.4 ± 0.8 mm (range 0.4–3.0 mm). Target depth and absolute tip error were not correlated (Pearson product-moment correlation coefficient, r = 0.01).

CONCLUSIONS

Use of the BJGA is feasible, accurate, effective, and safe for cannula placement, infusion MRI monitoring, and cannula adjustment during CED. The low-profile universal applicability of the BJGA streamlines and facilitates MRI-guided CED.

ABBREVIATIONS AADC = aromatic l-amino acid decarboxylase; AAV = adeno-associated virus; BJGA = ball-joint guide array; CED = convection-enhanced delivery; PEEK = polyetheretherketone.

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Contributor Notes

Correspondence Krystof S. Bankiewicz: The Ohio State University Wexner Medical Center, Columbus, OH. krzysztof.bankiewicz@osumc.edu.

INCLUDE WHEN CITING Published online October 23, 2020; DOI: 10.3171/2020.6.JNS201564.

Disclosures Dr. Bankiewicz holds the patent for the ball-joint guide array device and is a founder and chief executive officer (stockholder) for Brain Neurotherapy Bio, Inc., which holds the exclusive license for this technology. Dr. Lonser is a scientific founder (stockholder) of Brain Neurotherapy Bio, Inc.

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