Aim:Successful deep brain stimulation (DBS) requires precise electrode placement. However, brain shift from loss of cerebrospinal fluid or pneumocephalus still affects aim accuracy. Multidetector computed tomography (MDCT) provides absolute spatial sensitivity, and intraoperative cone-beam computed tomography (iCBCT) has become increasingly used in DBS procedures. However, its accuracy is unclear. We examined iCBCT accuracy and the need for postoperative imaging to confirm electrode position and assess complications of DBS surgery.Material and Methods:Thirty-two movement disorder patients, and 69 targets were retrospectively reviewed. All patients had preoperative non-stereotactic 3.0 Tesla magnetic resonance imaging (MRI), preoperative stereotactic MDCT, post-implantation iCBCT, and postoperative conventional MDCT scans. Stereotactic coordinates of electrode tips were compared between postoperative MDCT and iCBCT. We calculated the absolute and Euclidian differences (ED) between iCBCT and postoperative MDCT coordinates for each electrode. To assess whether intraoperative brain shifting influenced electrode tip localisation, subdural pneumocephalus volume was measured in iCBCT images.Results:The mean absolute (scalar) differences in x, y, and z coordinates were not significantly different from the absolute precision value of 0 (p>0.05). The mean ED between the iCBCT electrode tip and the postoperative MDCT electrode tip coordinates was <1mm (0.55±0.03 mm) and differed significantly from zero (p<0.0001). There was no correlation between pneumocephalus volume and electrode coordinate deviation.Conclusion:iCBCT can eliminate the need for routine postoperative studies since it is a safe, effective, and rapid procedure that can be performed at any step of the surgery. It provides reliable and definitive confirmation of correct DBS electrode placement.