scholarly journals Asleep Deep Brain Stimulator Placement in the Intraoperative Magnetic Resonance Imaging System Hybrid Operating Suite: 2-Dimensional Operative Video

2020 ◽  
Author(s):  
Andrea A Brock ◽  
Bornali Kundu ◽  
John D Rolston
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Parkinson Disease ◽  
Awake Surgery ◽  
Microelectrode Recording ◽  
Resonance Imaging ◽  
Intraoperative Magnetic Resonance Imaging ◽  
Lead Placement ◽  
Operating Suite ◽  
Deep Brain

Abstract Asleep, image-guided deep brain stimulation (DBS) placement is rapidly gaining popularity because it offers greater patient comfort and comparable accuracy with frame-based methods using microelectrode recording.1 In this video, we demonstrate our protocol to use the frameless, stereotactic ClearPoint system (MRI Interventions Inc, Irvine, California) to place DBS electrodes within an intraoperative magnetic resonance imaging hybrid operating suite (IMRIS; Deerfield Imaging Inc, Minnetonka, Minnesota).1-4 This system uses a skull-mounted aiming device coupled with sequential, intraoperative magnetic resonance imaging guidance to direct DBS lead placement to subcortical targets.2,5 Importantly, this method allows the patient to remain asleep during the operation and does not require medication holidays or additional microelectrode recording equipment. The literature indicates it has comparable accuracy1,6 and outcomes2 with the awake method. We demonstrate this technique with the case of a patient with Parkinson disease who required lead placement in the bilateral subthalamic nuclei.7-9 The patient consented to the procedure and publication. Patient positioning, draping nuances, initial indirect targeting, and final direct targeting are demonstrated. Risks of the operation include a risk of hemorrhage, hardware failure, and infection.10 DBS is currently an underutilized treatment option for patients with Parkinson disease.11 Offering the asleep option may be more tolerable for many patients who are wary of awake surgery.

Successful Deep Brain Stimulation Surgery With Intraoperative Magnetic Resonance Imaging on a Difficult Neuroacanthocytosis Case

Neurosurgery ◽  
2013 ◽  
Vol 73 (1) ◽  
pp. E184-E188 ◽  
Author(s):  
Thien Thien Lim ◽  
Hubert H. Fernandez ◽  
Scott Cooper ◽  
Kathryn Mary K. Wilson ◽  
Andre G. Machado
Keyword(s):  
Magnetic Resonance Imaging ◽  
Deep Brain Stimulation ◽  
Magnetic Resonance ◽  
General Anesthesia ◽  
Brain Stimulation ◽  
Resonance Imaging ◽  
Imaging Guidance ◽  
Intraoperative Magnetic Resonance Imaging ◽  
Magnetic Resonance Imaging Guidance ◽  
Deep Brain

Abstract BACKGROUND AND IMPORTANCE: Chorea acanthocytosis is a progressive hereditary neurodegenerative disorder characterized by hyperkinetic movements, seizures, and acanthocytosis in the absence of any lipid abnormality. Medical treatment is typically limited and disappointing. CLINICAL PRESENTATION: We report on a 32-year-old patient with chorea acanthocytosis with a failed attempt at awake deep brain stimulation (DBS) surgery due to intraoperative seizures and postoperative intracranial hematoma. He then underwent a second DBS operation, but under general anesthesia and with intraoperative magnetic resonance imaging guidance. Marked improvement in his dystonia, chorea, and overall quality of life was noted 2 and 8 months postoperatively. CONCLUSION: DBS surgery of the bilateral globus pallidus pars interna may be useful in controlling the hyperkinetic movements in neuroacanthocytosis. Because of the high propensity for seizures in this disorder, DBS performed under general anesthesia, with intraoperative magnetic resonance imaging guidance, may allow successful implantation while maintaining accurate target localization.

Transient dystonia following magnetic resonance imaging in a patient with deep brain stimulation electrodes for the treatment of Parkinson disease

2003 ◽  
Vol 99 (4) ◽  
pp. 772-774 ◽  
Author(s):  
Jörg Spiegel ◽  
Gerhard Fuss ◽  
Martin Backens ◽  
Wolfgang Reith ◽  
Tim Magnus ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Deep Brain Stimulation ◽  
Magnetic Resonance ◽  
Mr Imaging ◽  
Parkinson Disease ◽  
Resonance Imaging ◽  
Content Type ◽  
Ballistic Movements ◽  
Fine Print ◽  
Deep Brain

✓ Data from previous studies have shown that magnetic resonance (MR) imaging of the head can be performed safely in patients with deep brain stimulators. The authors report on a 73-year-old patient with bilaterally implanted deep brain electrodes for the treatment of Parkinson disease, who exhibited dystonic and partially ballistic movements of the left leg immediately after an MR imaging session. Such dystonic or ballistic movements had not been previously observed in this patient. In the following months, this focal movement disorder resolved completely. This case demonstrates the possible risks of MR imaging in patients with deep brain stimulators.

Targeting Accuracy of the Subthalamic Nucleus in Deep Brain Stimulation Surgery: Comparison Between 3 T T2-Weighted Magnetic Resonance Imaging and Microelectrode Recording Results

2017 ◽  
Vol 15 (1) ◽  
pp. 66-71 ◽  
Author(s):  
Andreas Nowacki ◽  
Ines Debove ◽  
Michael Fiechter ◽  
Frédéric Rossi ◽  
Markus Florian Oertel ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Deep Brain Stimulation ◽  
Magnetic Resonance ◽  
Subthalamic Nucleus ◽  
Brain Stimulation ◽  
Microelectrode Recording ◽  
Resonance Imaging ◽  
Entry Points ◽  
Targeting Accuracy ◽  
Deep Brain

Abstract BACKGROUND Targeting accuracy in deep brain stimulation (DBS) surgery can be defined as the level of accordance between selected and anatomic real target reflected by characteristic electrophysiological results of microelectrode recording (MER). OBJECTIVE To determine the correspondence between the preoperative predicted target based on modern 3-T magnetic resonance imaging (MRI) and intraoperative MER results separately on the initial and consecutive second side of surgery. METHODS Retrospective cohort study of 86 trajectories of DBS electrodes implanted into the subthalamic nucleus (STN) of patients with Parkinson's disease. The entrance point of the electrode into the STN and the length of the electrode trajectory crossing the STN were determined by intraoperative MER findings and 3 T T2-weighted magnetic resonance images with 1-mm slice thickness. RESULTS Average difference between MRI- and MER-based trajectory lengths crossing the STN was 0.28 ± 1.02 mm (95% CI: −0.51 to −0.05 mm). There was a statistically significant difference between the MRI- and MER-based entry points on the initial and second side of surgery (P = .04). Forty-three percent of the patients had a difference of more than ±1 mm of the MRI-based-predicted and the MER-based-determined entry points into the STN with values ranging from −3.0 to + 4.5 mm. CONCLUSION STN MRI-based targeting is accurate in the majority of cases on the first and second side of surgery. In 43% of implanted electrodes, we found a relevant deviation of more than 1 mm, supporting the concept of MER as an important tool to guide and optimize targeting and electrode placement.

Magnetic Resonance-Based Deep Brain Stimulation Technique: A Series of 478 Consecutive Implanted Electrodes With No Perioperative Intracerebral Hemorrhage

2009 ◽  
Vol 65 (suppl_6) ◽  
pp. ons196-ons202 ◽  
Author(s):  
Igor Lima Maldonado ◽  
Thomas Roujeau ◽  
Laura Cif ◽  
Victoria Gonzalez ◽  
Hassan El-Fertit ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Deep Brain Stimulation ◽  
Magnetic Resonance ◽  
Parkinson Disease ◽  
General Anesthesia ◽  
Brain Stimulation ◽  
Resonance Imaging ◽  
Stereotactic Frame ◽  
Stimulation Technique ◽  
Deep Brain

Abstract Objective: The aim of this study was to determine the safety of a deep brain stimulation technique consisting of a combination of routine general anesthesia, magnetic resonance imaging direct targeting, and a single penetration technique in a large population of patients undergoing operation for movement disorders. Methods: One hundred ninety-four patients treated with deep brain stimulation between 1996 and 2007 were assessed via a computerized database for intra- and perioperative events. Most patients were young; only 62 of them were older than 40 years (mean age, 31.1 years). General anesthesia was induced in all cases before placement of a magnetic resonance imaging-compatible stereotactic frame. Electrode implantation was done under radioscopic control via a rigid immobile cannula using a single cerebral perforation. No perioperative microelectrode recording or neurostimulation testing was used. Systematic postoperative magnetic resonance imaging was performed before frame removal. Results: A total of 478 electrodes were implanted in 220 procedures: 426 for d ystonic-dyskinetic syndromes and 52 for Parkinson disease. The mean number of parenchymal penetrations per patient was 2.5 for the dystonic-dyskinetic syndrome group and 2.08 for the Parkinson disease group. Postimplantation magnetic resonance imaging detected no perioperative intraparenchymal hemorrhages. Conclusion: We consider that the risk of hemorrhagic complication is multifactorial but closely related to the chosen technique.

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