Brain Shift and Pneumocephalus Assessment During Frame-Based Deep Brain Stimulation Implantation With Intraoperative Magnetic Resonance Imaging

2017 ◽  
Vol 14 (6) ◽  
pp. 668-674 ◽  
Author(s):  
Caio M Matias ◽  
Leonardo A Frizon ◽  
Fadi Asfahan ◽  
Juan D Uribe ◽  
Andre G Machado
Keyword(s):  
Magnetic Resonance Imaging ◽  
Deep Brain Stimulation ◽  
Magnetic Resonance ◽  
Brain Stimulation ◽  
Anterior Commissure ◽  
Brain Shift ◽  
Resonance Imaging ◽  
Posterior Commissure ◽  
Anatomic Landmarks ◽  
Deep Brain

Abstract BACKGROUND Brain shift and pneumocephalus are major concerns regarding deep brain stimulation (DBS). OBJECTIVE To report the extent of brain shift in deep structures and pneumocephalus in intraoperative magnetic resonance imaging (MRI). METHODS Twenty patients underwent bilateral DBS implantation in an MRI suite. Volume of pneumocephalus, duration of procedure, and 6 anatomic landmarks (anterior commissure, posterior commissure, right fornix [RF], left fornix [LF], right putaminal point, and left putaminal point) were measured. RESULTS Pneumocephalus varied from 0 to 32 mL (median = 0.6 mL). Duration of the procedure was on average 195.5 min (118-268 min) and was not correlated with the amount of pneumocephalus. There was a significant posterior displacement of the anterior commissure (mean = −1.1 mm, P < .001), RF (mean = −0.6 mm, P < .001), LF (mean = −0.7 mm, P < .001), right putaminal point (mean = −0.9 mm, P = .001), and left putaminal point (mean = −1.0 mm, P = .001), but not of the posterior commissure (mean = 0.0 mm, P = .85). Both RF (mean = −.7 mm, P < .001) and LF (mean = −0.5 mm, P < .001) were posteriorly displaced after a right-sided burr hole. There was a correlation between anatomic landmarks displacement and pneumocephalus after 2 burr holes (rho = 0.61, P = .007), but not after 1 burr hole (rho = 0.16, P = .60). CONCLUSION Better understanding of how pneumocephalus displaces subcortical structures can significantly enhance our intraoperative decision making and overall targeting strategy.

What You See Is What You Get: Lead Location Within Deep Brain Structures Is Accurately Depicted by Stereotactic Magnetic Resonance Imaging

2015 ◽  
Vol 11 (3) ◽  
pp. 412-419 ◽  
Author(s):  
Jonathan A Hyam ◽  
Harith Akram ◽  
Thomas Foltynie ◽  
Patricia Limousin ◽  
Marwan Hariz ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Deep Brain Stimulation ◽  
Magnetic Resonance ◽  
Brain Stimulation ◽  
Anterior Commissure ◽  
Brain Structures ◽  
Lead Removal ◽  
Resonance Imaging ◽  
Lead Location ◽  
Deep Brain

Abstract BACKGROUND Magnetic resonance imaging (MRI)-verified deep brain stimulation relies on the correct interpretation of stereotactic imaging documenting lead location in relation to visible anatomic target. However, it has been suggested that local signal distortion from the lead itself renders its depiction on MRI unreliable. OBJECTIVE To compare lead location on stereotactic MRI with subsequent location of its brain track after removal. METHODS Patients underwent deep brain stimulation with the use of MRI-guided and MRI-verified Leksell frame approach. Infection or suboptimal efficacy required lead removal and subsequent reimplantation by using the same technique. Postimplantation stereotactic MR images were analyzed. Lateral (x) and anteroposterior (y) distances from midcommissural point to center of the lead hypointensity were recorded at the anterior commissure-posterior commissure plane (pallidal electrode) or z = −4 (subthalamic electrode). Stereotactic MRI before the second procedure, x and y distances from the center of the visible lead track hypointensity to midcommissural point were independently recorded. Vectorial distance from center of the lead hypointensity to the center of its track was calculated. RESULTS Sixteen electrode tracks were studied in 10 patients. Mean differences between lead artifact location and lead track location were: x coordinate 0.4 mm ± 0.2; y coordinate 0.6 mm ± 0.3. Mean vectorial distance was 0.7 mm ± 0.2. CONCLUSION Stereotactic distance between lead location and subsequent brain track location on MRI was small. The mean discrepancy was approximately half the deep brain stimulation lead width. This suggests that lead hypointensity seen on postimplantation MRI is indeed an accurate representation of its real location within deep brain structures.

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.

ISOLATION OF THE BRAIN‐RELATED FACTOR OF THE ERROR BETWEEN INTENDED AND ACHIEVED POSITION OF DEEP BRAIN STIMULATION ELECTRODES IMPLANTED INTO THE SUBTHALAMIC NUCLEUS FOR THE TREATMENT OF PARKINSON'S DISEASE

2009 ◽  
Vol 64 (suppl_5) ◽  
pp. ons374-ons384 ◽  
Author(s):  
Slawomir Daniluk ◽  
Keith G. Davies ◽  
Peter Novak ◽  
Thai Vu ◽  
Jules M. Nazzaro ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Deep Brain Stimulation ◽  
Magnetic Resonance ◽  
Subthalamic Nucleus ◽  
Brain Stimulation ◽  
Related Factor ◽  
Technical Error ◽  
Resonance Imaging ◽  
Computed Tomographic ◽  
Deep Brain

Abstract OBJECTIVE Although a few studies have quantified errors in the implantation of deep brain stimulation electrodes into the subthalamic nucleus (STN), a significant trend in error direction has not been reported. We have previously found that an error in axial plane, which is of most concern because it cannot be compensated for during deep brain stimulation programming, had a posteromedial trend. We hypothesized that this trend results from a predominance of a directionally oriented error factor of brain origin. Accordingly, elimination of nonbrain (technical) error factors could augment this trend. Thus, implantation accuracy could be improved by anterolateral compensation during target planning. METHODS Surgical technique was revised to minimize technical error factors. During 22 implantations, targets were selected on axial magnetic resonance imaging scans up to 1.5 mm anterolateral from the STN center. Using fusion of postoperative computed tomographic and preoperative magnetic resonance imaging scans, implantation errors in the axial plane were obtained and compared with distances from the lead to the STN to evaluate the benefit of anterolateral compensation. RESULTS Twenty errors and the mean error had a posteromedial direction. The average distances from the lead to the target and to the STN were 1.7 mm (range, 0.8–3.1 mm) and 1.1 mm (range, 0.1–1.9 mm), respectively. The difference between the 2 distances was significant (paired t test, P < 0.0001). The lower parts of the lead were consistently bent in the posteromedial direction on postoperative scout computed tomographic scans, suggesting that a brain-related factor is responsible for the reported error. CONCLUSION Elimination of the technical factors of error during STN deep brain stimulation implantation can result in a consistent posteromedial error. Implantation accuracy may be improved by compensation for this error in advance.

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