Accuracy and Distortion of Deep Brain Stimulation Electrodes on Postoperative MRI and CT

The authors report on a case of tinnitus suppression following deep brain stimulation (DBS) for Parkinson disease. A perioperative focal vascular injury to area LC, a locus of the caudate at the junction of the head and body of the caudate nucleus, is believed to be the neuroanatomical correlate. A 56-year-old woman underwent surgery for implantation of a DBS lead in the subthalamic nucleus to treat medically refractory motor symptoms. She had comorbid tinnitus localized to both ears. The lead trajectory was adjacent to area LC. Shortly after surgery, she reported tinnitus suppression in both ears. Postoperative MRI showed focal hyperintensity of area LC on T2-weighted images. At 18 months, tinnitus localized to the ipsilateral ear remained completely silenced, and tinnitus localized to the contralateral ear was substantially suppressed due to left area LC injury. To the authors' knowledge, this is the first report of a discrete injury to area LC that resulted in bilateral tinnitus suppression. Clinicians treating patients with DBS may wish to include auditory phantom assessment as part of the neurological evaluation.

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Correlation of diffusion tensor tractography and intraoperative macrostimulation during deep brain stimulation for Parkinson disease

Journal of Neurosurgery ◽

10.3171/2014.6.jns131673 ◽

2014 ◽

Vol 121 (4) ◽

pp. 929-935 ◽

Cited By ~ 11

Author(s):

Nicholas Said ◽

W. Jeff Elias ◽

Prashant Raghavan ◽

Alan Cupino ◽

Nicholas Tustison ◽

...

Keyword(s):

Deep Brain Stimulation ◽

Parkinson Disease ◽

Brain Stimulation ◽

Diffusion Tensor ◽

Distance Measurements ◽

Postoperative Mri ◽

Mri Studies ◽

Lead Placement ◽

Dti Tractography ◽

Deep Brain

Object The purpose of this study was to investigate whether diffusion tensor imaging (DTI) of the corticospinal tract (CST) is a reliable surrogate for intraoperative macrostimulation through the deep brain stimulation (DBS) leads. The authors hypothesized that the distance on MRI from the DBS lead to the CST as determined by DTI would correlate with intraoperative motor thresholds from macrostimulations through the same DBS lead. Methods The authors retrospectively reviewed pre- and postoperative MRI studies and intraoperative macrostimulation recordings in 17 patients with Parkinson disease (PD) treated by DBS stimulation. Preoperative DTI tractography of the CST was coregistered with postoperative MRI studies showing the position of the DBS leads. The shortest distance and the angle from each contact of each DBS lead to the CST was automatically calculated using software-based analysis. The distance measurements calculated for each contact were evaluated with respect to the intraoperative voltage thresholds that elicited a motor response at each contact. Results There was a nonsignificant trend for voltage thresholds to increase when the distances between the DBS leads and the CST increased. There was a significant correlation between the angle and the voltage, but the correlation was weak (coefficient of correlation [R] = 0.36). Conclusions Caution needs to be exercised when using DTI tractography information to guide DBS lead placement in patients with PD. Further studies are needed to compare DTI tractography measurements with other approaches such as microelectrode recordings and conventional intraoperative MRI–guided placement of DBS leads.

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Intraoperative Computed Tomography for Deep Brain Stimulation Surgery: Technique and Accuracy Assessment

Operative Neurosurgery ◽

10.1227/neu.0b013e31820781bc ◽

2011 ◽

Vol 68 (suppl_1) ◽

pp. ons114-ons124 ◽

Cited By ~ 23

Author(s):

Kiarash Shahlaie ◽

Paul S Larson ◽

Philip A Starr

Keyword(s):

Computed Tomography ◽

Deep Brain Stimulation ◽

Brain Stimulation ◽

Intraoperative Computed Tomography ◽

3 Dimensional ◽

Postoperative Mri ◽

Stereotactic Frame ◽

Head Positioning ◽

Lead Location ◽

Deep Brain

Abstract BACKGROUND: The efficacy of deep brain stimulation (DBS) is highly dependent on the accuracy of lead placement. OBJECTIVE: To describe the use of intraoperative computed tomography (iCT) to confirm lead location before surgical closure and to study the accuracy of this technique. METHODS: Fifteen patients underwent awake microelectrode-guided DBS surgery in a stereotactic frame. A portable iCT scanner (Medtronic O-arm) was positioned around the patient's head throughout the procedure and was used to confirm lead location before fixation of the lead to the skull. Images were computationally fused with preoperative magnetic resonance imaging (MRI), and lead tip coordinates with respect to the midpoint of the anterior commissure-posterior commissure line were measured. Tip coordinates were compared with those obtained from postoperative MRI. RESULTS: iCT was integrated into standard frame-based microelectrode-guided DBS surgery with a minimal increase in surgical time or complexity. Technically adequate 2-dimensional and 3-dimensional images were obtained in all cases. Head positioning and fixation techniques that allow unobstructed imaging are described. Lead tip measurements on iCT fused with preoperative MRI were statistically indistinguishable from those obtained with postoperative MRI. CONCLUSION: iCT can be easily incorporated into standard DBS surgery, replaces the need for C-arm fluoroscopy, and provides accurate intraoperative 3-dimensional confirmation of electrode tip locations relative to preoperative images and surgical plans. iCT fused to preoperative MRI may obviate the need for routine postoperative MRI in DBS surgery. Technical nuances that must be mastered for the efficient use of iCT during DBS implantation are described.

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Postoperative MRI localisation of electrodes and clinical efficacy of pallidal deep brain stimulation in cervical dystonia

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp-2014-308159 ◽

2014 ◽

Vol 86 (8) ◽

pp. 833-839 ◽

Cited By ~ 18

Author(s):

Thomas Schönecker ◽

Doreen Gruber ◽

Anatol Kivi ◽

Bianca Müller ◽

Elmar Lobsien ◽

...

Keyword(s):

Deep Brain Stimulation ◽

Clinical Efficacy ◽

Brain Stimulation ◽

Cervical Dystonia ◽

Postoperative Mri ◽

Pallidal Deep Brain Stimulation ◽

Deep Brain

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Stereotactic Accuracy and Surgical Utility of the O-Arm in Deep Brain Stimulation Surgery

Operative Neurosurgery ◽

10.1227/neu.0000000000001326 ◽

2016 ◽

Vol 13 (1) ◽

pp. 96-107 ◽

Cited By ~ 10

Author(s):

Jonathan Dennis Carlson ◽

Kate Elizabeth McLeod ◽

Pamela Sue McLeod ◽

Jamelynn Brooke Mark

Keyword(s):

Deep Brain Stimulation ◽

Brain Stimulation ◽

Intraoperative Imaging ◽

Electrode Placement ◽

Electrode Position ◽

Radial Error ◽

Postoperative Mri ◽

Magnetic Resonance Imaging Mri ◽

The Impact ◽

Deep Brain

Abstract BACKGROUND: The stereotactic accuracy of intraoperative imaging is critical to clinical outcome, particularly in “asleep” deep brain stimulation (DBS) surgery that typically forgoes neurophysiological techniques. Different intraoperative imaging modalities and associated accuracies have been reported, including magnetic resonance imaging (MRI), computed tomography (CT), and O-arm. OBJECTIVE: To analyze intraoperative O-arm imaging accuracy and to evaluate the utility of microelectrode mapping. METHODS: O-arm images of DBS electrodes were collected during implantation in the subthalamic nucleus in patients with Parkinson disease. Images were fused to postoperative MRI and postoperative CT scans. Stereotactic coordinates for the electrode tip were measured independently. Radial distances between the images were compared. The impact of microelectrode mapping on final DBS electrode positioning was also evaluated. RESULTS: In 71 consecutive DBS electrodes, the average radial error of the electrode tip between the O-arm and MRI was 1.55 ± 0.58 mm. The average radial error between the O-arm and CT was 1.03 ± 0.61 mm. Thus, the O-arm images accurately depicted the position of the electrode. However, in 14% of cases, microelectrode mapping revised the DBS electrode position beyond the preoperative direct target in combination with accurate intraoperative imaging. CONCLUSION: Intraoperative O-arm images reliably and accurately displayed the location of the DBS electrode compared with postoperative CT and MRI images. Microelectrode mapping provided superior subnuclear resolution to imaging. Both intraoperative imaging and microelectrode mapping are effective tools that can be synergistically combined for optimal DBS electrode placement.

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Postoperative MRI examinations in patients treated by deep brain stimulation using a non-standard protocol

Acta Neurochirurgica ◽

10.1007/s00701-010-0738-y ◽

2010 ◽

Vol 152 (12) ◽

pp. 2021-2027 ◽

Cited By ~ 11

Author(s):

Lutz M. Weise ◽

Gerd H. Schneider ◽

Andreas Kupsch ◽

Jens Haumesser ◽

Karl T. Hoffmann

Keyword(s):

Deep Brain Stimulation ◽

Brain Stimulation ◽

Standard Protocol ◽

Postoperative Mri ◽

Deep Brain

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Prospective Evaluation of the Time Course of White Matter Edema Associated with Implanted Deep Brain Stimulation Electrodes

Stereotactic and Functional Neurosurgery ◽

10.1159/000511115 ◽

2020 ◽

pp. 1-4

Author(s):

Mark J. Nolt ◽

Rajeev S. Polasani ◽

Taras W. Masnyk ◽

Michael Rezak ◽

Joshua M. Rosenow

Keyword(s):

Deep Brain Stimulation ◽

White Matter ◽

Brain Stimulation ◽

Time Course ◽

Postoperative Mri ◽

Course Of Action ◽

Signal Change ◽

Mri Scans ◽

Deep Brain ◽

Time Point

Introduction: Deep brain stimulation (DBS) is commonly used in the treatment of medically refractory movement disorders. There have been several reports in the literature of edema developing around the implanted electrode. Most of these studies have been retrospective, suggesting that the time course and incidence of this edema are underestimated. An understanding of the incidence and time course of edema related to DBS leads is important to allow clinicians to better assess the correct course of action when edema following DBS implantation is observed. Methods: We examined both the time course and prevalence of edema following DBS implantation by obtaining a series of postoperative MRI scans from patients who underwent DBS surgery. Edema volume was quantified by a single neuroradiologist, measuring the peri-electrode T2 signal change. Results: We examined postoperative MRIs in thirteen patients with fifteen DBS electrode implants. Eleven patients exhibited white matter edema on at least 1 postoperative MRI, with none being symptomatic. Edema was completely resolved in 4 of the electrode implants through postoperative day 70, with the remaining cases still exhibiting edema at the last imaged time point. Discussion/Conclusion: In this study, we obtained a regimented series of postoperative MRIs in an effort to determine the time course and incidence of edema. Our results show that edema following DBS implant is not rare, is often asymptomatic, and may resolve over many weeks.

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Influence of stereotactic imaging on operative time in deep brain stimulation

Surgical Neurology International ◽

10.25259/sni_763_2020 ◽

2021 ◽

Vol 12 ◽

pp. 82

Author(s):

Heather Pinckard-Dover ◽

Hytham Al-Hindi ◽

Grace Goode ◽

Hayden Scott ◽

Erika Petersen

Keyword(s):

Deep Brain Stimulation ◽

Brain Stimulation ◽

Retrospective Chart Review ◽

Patient Comfort ◽

Procedure Time ◽

Postoperative Mri ◽

Lead Placement ◽

Intraoperative Fluoroscopy ◽

Room Time ◽

Deep Brain

Background: Various techniques are used across institutions for implantation of deep brain stimulation (DBS) leads. The most used techniques for each step include preoperative MRI fused to in-frame CT, intraoperative fluoroscopy, and postoperative CT, but postimplantation MRI also is used, as it was at our center. We present the quality assurance study performed at our institution after a change from postimplantation MRI performed across the hospital to postimplantation in room CT. Methods: Retrospective chart review of 123 patients who underwent bilateral DBS leads placement without same-day generator placement that was performed. The patients were divided by the type of postoperative imaging that was obtained. Patients were excluded if a unilateral lead placement was performed, if the case was a revision of an existing lead or deviated from the normal protocol. Operative room times and procedure times for each group were analyzed with Wilcoxon rank sums test (WRST) to determine any significant differences between groups. Results: Postoperative MRI was performed for 82 patients, while postoperative CT was performed for 41 patients. A WRST showed a significant reduction in both operative room time (209 min to 170 min, P < 0.0001) and procedure time (140 min to 126 min, P = 0.0019). Conclusion: In-room CT allowed for a significant reduction in operative room time. Lower operative room time has been associated with increased patient comfort, and decreased cost. CT did not alter the revision rate for procedures. The significant reduction in procedure time may be attributed to increased team familiarity with procedure over time.

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