Framelink

Manufactured by Medtronic

Sourced in United States

Framelink is a laboratory equipment product designed for secure sample management. It provides a structured framework for organizing and tracking samples within a laboratory environment.

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Lab products found in correlation

Stealthviz software, by Medtronic (1 mentions) Activa pc, by Medtronic (1 mentions) Vercise, by Boston Scientific (1 mentions) Activa rc, by Medtronic (1 mentions) Quadripolar electrodes, by Medtronic (1 mentions) 3t mri scanner, by Siemens (1 mentions) Visualase, by Medtronic (1 mentions) Leksell stereotactic system, by Elekta (1 mentions)

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Framelink 5.0 (4 citations) Framelink software (4 citations) Stealth Station Framelink (3 citations) STEALTH Framelink (2 citations)

8 protocols using framelink

Subthalamic Nucleus DBS: Surgical Approach

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Fifty-four consecutive patients who underwent bilateral STN DBS between 2005 and 2007 participated in this study (Table 1). They were assessed before and at one year following surgery.
The study was approved by the National Hospital for Neurology and Neurosurgery and the Institute of Neurology joint Research Ethics Committee (ref nr: 03/NI38).
Surgical procedure and contact localisation were performed as previously described^{16 (link),17 (link),18 (link),4 (link)}: The subthalamic target was visualized on preoperative stereotactic MRI at 1.5T using T2-weighted, fast-acquisition sequences in all patients. Postoperative stereotactic MR images using an identical sequence were imported into the planning software allowing 3-dimensional reconstruction of the images along the electrode trajectory (FrameLink, Medtronic). Stereotactic localization of the four electrode contacts was performed using a template superimposed on the electrode artifact^{47 (link)}. The coordinates of each contact were transposed onto the preoperative stereotactic MRI. Two neurosurgeons (LZ, MH) blinded to the results of STN-DBS on speech, independently assessed and agreed on the anatomic position of each contact in relation to the visualized STN in the axial and coronal planes.

Tripoliti E., Limousin P., Foltynie T., Candelario J., Aviles-Olmos I., Hariz M.I, & Zrinzo L. (2014). Predictive factors of speech intelligibility following subthalamic nucleus stimulation in consecutive patients with Parkinson’s disease. Movement disorders : official journal of the Movement Disorder Society, 29(4), 532-538.

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Targeting Deep Brain Stimulation Electrodes

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Postoperative helical computed tomography (CT) was fused to preoperative planning in the FrameLink software (Medtronic, USA) including the DTI rendition of the DRT. The MCP system had been defined based on MRI. Visualization of the final DBS electrode was used as a reference to simulate intraoperative test electrode positions (final implantation depth as determined with intraoperative fluoroscopy was taken into account). If a different path (e.g., anterior) had been used during surgery, a respective tract parallel to the final DBS electrode was defined. MCP coordinates of the intraoperative stimulation points were simulated and recorded. From each individual stimulation point, a measurement of the Euclidian shortest distance to the border of the DRT (Db) and the center of the DRT (Dc) was performed in the correlated triplanar display (axial, coronal, sagittal) and additionally perpendicular views to the trajectory (probe’s eye view). Distance to (in mm) and actual MCP coordinates of DRT border and DRT center were recorded (cf. Fig. 2).

Coenen V.A., Sajonz B., Prokop T., Reisert M., Piroth T., Urbach H., Jenkner C, & Reinacher P.C. (2020). The dentato-rubro-thalamic tract as the potential common deep brain stimulation target for tremor of various origin: an observational case series. Acta Neurochirurgica, 162(5), 1053-1066.

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Stereotactic Analysis of Post-op MRI Scans

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Stereotactic analysis of all postoperative MRI scans was performed in a blinded fashion by a single rater. Both preoperative and postoperative MRI scan sets were imported into a stereotactic surgical planning software package (FrameLink, Medtronic, Inc.), computationally fused, and reformatted to produce images orthogonal to the anterior commissure–posterior commissure line and midsagittal plane.^{20 (link)} Data collected included the position of the deepest contact, the coronal and sagittal angles of the trajectory, the distance of the bur hole from the midline and target, the coordinates of the active contact and the distance of that contact from the fornix, lead and fornix coordinates at z = 0, lead and mammillary body coordinates at the level of the mammillary bodies, ventricular width, third ventricular width, skull width,^{4 (link)} and the sagittal angle of the column of the fornix. In addition, there were 54 leads for which the coordinates for the preoperative stereotactic plan were documented; for these leads, the vector and radial errors relative to the final lead placement (Fig. 1) were collected. Pearson’s correlation coefficients were used to measure the extent of the linear association between 2 variables.

Ponce F.A., Asaad W.F., Foote K.D., Anderson W.S., Cosgrove G.R., Baltuch G.H., Beasley K., Reymers D.E., Oh E.S., Targum S.D., Smith G.S., Lyketsos C.G, & Lozano A.M. (2015). Bilateral deep brain stimulation of the fornix for Alzheimer’s disease: surgical safety in the ADvance trial. Journal of neurosurgery, 125(1), 75-84.

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Electrode Placement Verification in DBS Surgery

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Images of immediate postoperative computed tomography (CT, 1-mm-thick axial slices) were transferred and merged to preoperative volumetric T1-weighted magnetic resonance (MR) images to verify the location of the electrodes.9 (link),12 (link) The location of the quadripolar electrodes was assessed using a fusion of the postoperative CT images on the preoperative volumetric T1 MR images in the Framelink^® software (Medtronic). The center of the contacts used as cathodes was identified with adjustment of contrast and brightness, and lead location was then measured as a variable in three dimensions with respect to the PC.9 (link),12 (link) In addition, the laterality from the wall of the third ventricle, as measured on the axial plane corresponding to the center of the active contact, was measured, because we often encountered a large third ventricle in refractory epilepsy patients with encephalomalacia and resultant difficulty in determination of the laterality of target coordinates. Lead locations were plotted with respect to a drawing adapted from a stereotactic atlas of the human thalamus.21 Targeting of the electrode was defined as successful when at least two electrode contacts were identified within the ANT or CM in postoperative CT/preoperative MRI fusion images.

Son B.C., Shon Y.M., Kim S.H., Kim J., Ko H.C, & Choi J.G. (2018). Technical Implications in Revision Surgery for Deep Brain Stimulation (DBS) of the Thalamus for Refractory Epilepsy. Journal of Epilepsy Research, 8(1), 12-19.

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Deep Brain Stimulation Targeting Methodology

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Pre-operatively, diffusion, T2, and T1-weighted post-gadolinium sequences were acquired on a 3-Tesla magnetic resonance imaging (MRI) system, as described previously^{1 (link)}.
Each patient’s MFB was individually mapped by means of deterministic fiber tracking using diffusion sequences. An area lateral to the VTA, anterior to the red nucleus, and posterior to the mammillary bodies was used as the seed region, as described by Coenen et al.^{27 (link)}. Using StealthViz software (Medtronic, Inc.), such mapping resulted in clear projections of the slMFB through to the medial prefrontal cortex. Results of such fiber tracking were then transferred to the stereotactic planning software (Framelink, Medtronic, Inc.), where the center of this fiber bundle superolateral to the VTA was used as the target for the DBS electrode, as previously described^{1 (link),2 (link)}.

Fenoy A.J., Schulz P.E., Selvaraj S., Burrows C.L., Zunta-Soares G., Durkin K., Zanotti-Fregonara P., Quevedo J, & Soares J.C. (2018). A longitudinal study on deep brain stimulation of the medial forebrain bundle for treatment-resistant depression. Translational Psychiatry, 8, 111.

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Deep Brain Stimulation Procedure

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The general surgical procedure has been published in detail before. Patients are operated under local anesthesia with sedation (remifentanil and propofol).
In summary, after fixation of the stereotactic frame (CRW Stereotactic System, Integra Neurosciences, or Riechert-Mundinger frame), planning is performed on fused stereotactic CT/MRI images, with the Framelink (Medtronic Inc.) or STP 3.5 (Leibinger) planning station.
The trajectory is planned so that both VIM and PSA can be stimulated, with one electrode contact on the AC-PC level. Macrostimulation is performed in all patients. Microrecording is selected in a number of patients based on the surgeon’s preference. Implanted electrodes are quadripolar electrodes from Medtronic Inc. (model 3387 or 3389) or octopolar electrodes from Boston Scientific (model 616010).
Finally, the pulse generator (Activa PC, model 37601; Activa RC, model 37612, Medtronic, USA or Vercise, Boston Scientific, USA) is implanted subcutaneously in the infraclavicular or lateral abdominal region under general anesthesia.

Barbe M.T., Franklin J., Kraus D., Reker P., Dembek T.A., Allert N., Wirths J., Voges J., Timmermann L, & Visser-Vandewalle V. (2016). Deep brain stimulation of the posterior subthalamic area and the thalamus in patients with essential tremor: study protocol for a randomized controlled pilot trial. Trials, 17, 476.

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Laser Ablation Using Visualase System

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All patients underwent laser ablation using the Visualase (Medtronic) system. The laser catheter was placed using stereotactic guidance via the CRW (Integra) frame in the operating room after induction of general anesthesia; target coordinates were determined using a preoperative registration MRI scan and the Framelink (Medtronic) software. After placement, real-time MR thermometry was performed using a Siemens 3-T MRI scanner, and ablation was performed using the Visualase workstation under direction of the senior author (J.G.O.). After treatment, postablation MRI sequences were obtained, the catheter was removed, and the patient was observed in the hospital.

Buckley R.T., Wang A.C., Miller J.W., Novotny E.J, & Ojemann J.G. (2016). Stereotactic laser ablation for hypothalamic and deep intraventricular lesions. Neurosurgical focus, 41(4).

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Stereotactic Biopsy Procedure with MRI-CT Fusion

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During this most recent period, the Leksell stereotactic system (Elekta Instruments, Inc., Stockholm, Sweden) 26 and a Sedan/Nashold biopsy needle (Elekta Instruments, Stockholm, Sweden) 25 were used.
The hospital had a 64-slice CT scan (General Electric, Boston, Massachusetts, United States) and a 3T MRI (General Electric, Boston, Massachusetts, United States).
In most cases, targets were established on the most suitable MRI sequence, which was later fused with a stereotactic CT scan. The coordinates were obtained with Framelink and the Cranial v.3.0 planning program (Medtronic, Minneapolis, United States) (►Fig. 3a).
The most experienced stereotactic neurosurgeon retired during this period.
During all three periods, the biopsy technique consisted of making a drill or a burr hole and obtaining tissue samples comprising three or four cylinders at different depths of the trajectory of the needle on its way across the target, or targets, on the lesion.
Patients were monitored in the intensive care unit or recovery room for 24 hours after the biopsy was obtained. During the first two periods, postoperative control brain CT scans were only performed if there was a clinical deterioration of the patient, whereas in period 3, brain CT scans were ordered routinely 24 hours after the intervention.

Lara-Almunia M, & Hernandez-Vicente J. (2019). Frame-based Stereotactic Biopsy: Description and Association of Anatomical, Radiologic, and Surgical Variables with Diagnostic Yield in a Series of 407 Cases. Journal of neurological surgery. Part A, Central European neurosurgery, 80(3).

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