Determining the Rotational Orientation of Directional Deep Brain Stimulation Leads Employing Flat-Panel Computed Tomography

2018 ◽  
Vol 16 (4) ◽  
pp. 465-470 ◽  
Author(s):  
Stefan Hunsche ◽  
Clemens Neudorfer ◽  
Faycal El Majdoub ◽  
Mohammad Maarouf ◽  
Dieter Sauner
Keyword(s):  
Computed Tomography ◽  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Flat Panel ◽  
Data Set ◽  
3 Dimensional ◽  
Rotational Orientation ◽  
Deep Brain ◽  
Stimulation Of

Abstract BACKGROUND Directional deep brain stimulation (DBS) constitutes an emerging technology that allows selective stimulation of target structures via partitioned electrode contacts. In order to effectively perform target-tailored stimulation, knowledge of the rotational orientation of the segmented leads is imperative. OBJECTIVE To develop a universally applicable and reliable method for determination of lead orientation angles in DBS using flat-panel computed tomography (fpCT). METHODS A binary template of directional leads DB-2202-30 (Boston Scientific, Natick, Massachusetts) and 6170 (Abbott, Plano, Texas) was imported into the 2-dimensional raw data set of a conventional fpCT scan. The template was aligned with and manually rotated around the predetermined lead trajectory. The overall orientation of the segmented lead can be deduced by transferring position and orientation of the lead orientation marker into the 3-dimensional volume. Accuracy of the method was investigated by two raters in a phantom study. RESULTS Accuracy were 5.4° ± 4.1° (range: 0.4°-11.9°) for rater 1 and 5.2° ± 3.0° (range: 0.3°-10.2°) for rater 2, when investigating DB-2202-30. For 6170 observed deviations were 2.5° ± 1.7° (range: 0.2°-5.2°) and 4.3° ± 3.6° (range: 0.2°-11.2°) for raters 1 and 2, respectively. CONCLUSION fpCT imaging constitutes a precise and accurate means to determine the rotational orientation of directional leads. The approach is universally transferable to different electrode designs as the template can easily be adjusted to the electrodes’ specific measures. The approach is independent from polar implantation angles owing to fpCT- and methodological features.

SUSCEPTIBILITY-ENHANCED 3-TESLA T1-WEIGHTED SPOILED GRADIENT ECHO OF THE MIDBRAIN NUCLEI FOR GUIDANCE OF DEEP BRAIN STIMULATION IMPLANTATION

Neurosurgery ◽  
2009 ◽  
Vol 65 (4) ◽  
pp. 809-815 ◽  
Author(s):  
Geoffrey S. Young ◽  
Feng Feng ◽  
Hao Shen ◽  
Nan-kuei Chen
Keyword(s):  
Steady State ◽  
Deep Brain Stimulation ◽  
Subthalamic Nucleus ◽  
Brain Stimulation ◽  
Surgical Planning ◽  
Spin Echo ◽  
Fast Spin Echo ◽  
Data Set ◽  
3 Dimensional ◽  
Deep Brain

Abstract SURGICAL PLANNING FOR deep brain stimulation implantation procedures requires T1-weighted imaging (T1WI) for stereotactic navigation. Because the subthalamic nucleus, the main target for deep brain stimulation, and other midbrain nuclei cannot be visualized on the stereotactic guidance T1WI, additional T2-weighted imaging (T2WI) is generally obtained and registered to the T1WI for surgical targeting. Surgical planning based on the registration of the 2 data sets is subject to error resulting from inconsistent geometric distortions and any subject movement between the 2 scans. In this article, we propose a new method to produce susceptibility-enhanced, contrast-optimized T1-weighted 3-dimensional spoiled gradient recalled acquisition in steady state images with enhanced contrast for midbrain nuclei within the volumetric T1WI data set itself, eliminating the need for additional T2WI. The scan parameters of 3-dimensional spoiled gradient recalled acquisition in steady state are chosen in a way that T1WI can be obtained from conventional magnitude reconstruction and images with improved contrast between midbrain nuclei and surrounding tissues can be produced from the same data by performing susceptibility-weighted imaging reconstruction on a chosen region of interest. In addition, our preliminary experience suggests that the resulting contrast between the midbrain nuclei is superior to the current state-of-the-art fast spin echo T2WI in depicting the subthalamic nucleus as distinct from the substantia nigra pars reticulata and clear depiction of the nucleus ventrointermedius externus of thalamus.

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

2011 ◽  
Vol 68 (suppl_1) ◽  
pp. ons114-ons124 ◽  
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.

Articulatory Closure Proficiency in Patients With Parkinson's Disease Following Deep Brain Stimulation of the Subthalamic Nucleus and Caudal Zona Incerta

2014 ◽  
Vol 57 (4) ◽  
pp. 1178-1190 ◽  
Author(s):  
Fredrik Karlsson ◽  
Katarina Olofsson ◽  
Patric Blomstedt ◽  
Jan Linder ◽  
Erik Nordh ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Deep Brain Stimulation ◽  
Subthalamic Nucleus ◽  
Brain Stimulation ◽  
Zona Incerta ◽  
Relative Duration ◽  
Data Set ◽  
Deep Brain ◽  
Stimulation Of

PurposeThe present study aimed at comparing the effects of deep brain stimulation (DBS) treatment of the subthalamic nucleus (STN) and the caudal zona incerta (cZi) on the proficiency in achieving oral closure and release during plosive production of people with Parkinson's disease.MethodNineteen patients participated preoperatively and 12 months after DBS surgery. Nine patients had implantations in the STN, 7 bilaterally and 2 unilaterally (left). Ten had bilateral implantations in the cZi. Postoperative examinations were made off and on stimulation. All patients received simultaneous L-dopa treatment in all conditions. For a series of plosives extracted from a reading passage, absolute and relative measures of duration of frication and amplitude of plosive release were compared between conditions within each treatment group.ResultsRelative duration of frication increased in voiceless plosives in the on-stimulation condition in cZi patients. Similar trends were observed across the data set. Duration of prerelease frication and the release peak prominence increased in voiceless plosives on stimulation for both groups.ConclusionThe increased release prominence suggests that patients achieved a stronger closure gesture because of DBS but that the increased energy available resulted in increased frication.

Deep brain stimulation modulates hypothalamic-brainstem fibers in cluster headache: case report

2020 ◽  
Vol 132 (3) ◽  
pp. 717-720 ◽  
Author(s):  
Sérgio A. F. Dantas ◽  
Eduardo J. L. Alho ◽  
Juliano J. da Silva ◽  
Nilson N. Mendes Neto ◽  
Erich Talamoni Fonoff ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Cluster Headache ◽  
Brain Stimulation ◽  
Clinical Effects ◽  
Chronic Stimulation ◽  
Mammillary Bodies ◽  
Fiber Tracts ◽  
White Matter Region ◽  
Deep Brain ◽  
Stimulation Of

Hypothalamic deep brain stimulation (DBS) has been used for more than a decade to treat cluster headache (CH) but its mechanisms remain poorly understood. The authors have successfully treated a patient with CH using hypothalamic DBS and found that the contact used for chronic stimulation was located in a white matter region posterior to the mammillary bodies. Fiber tracts crossing that region were the medial forebrain bundle and those interconnecting the hypothalamus and brainstem, including the dorsal longitudinal fasciculus. Because the stimulation of axons is an important mechanism of DBS, some of its clinical effects in CH may be related to the stimulation of fibers interconnecting the hypothalamus and brainstem.

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