scholarly journals An Unusual Case of Asystole Occurring during Deep Brain Stimulation Surgery

2016 ◽  
Vol 2016 ◽  
pp. 1-5
Author(s):  
Ha Son Nguyen ◽  
Harvey Woehlck ◽  
Peter Pahapill
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Unusual Case ◽  
Case Presentation ◽  
Volume State ◽  
Lead Placement ◽  
History Of ◽  
Symptomatic Bradycardia ◽  
Deep Brain Stimulation Surgery ◽  
Deep Brain

Background. Symptomatic bradycardia and hypotension in neurosurgery can produce severe consequences if not managed appropriately. The literature is scarce regarding its occurrence during deep brain stimulation (DBS) surgery.Case Presentation. A 67-year-old female presented for left DBS lead placement for essential tremors. During lead implantation, heart rate and blood pressure dropped rapidly; the patient became unresponsive and asystolic. Chest compressions were initiated and epinephrine was given. Within 30 seconds, the patient became hemodynamically stable and conscious. A head CT demonstrated no acute findings. After deliberation, a decision was made to complete the procedure. Assuming the etiology of the episode was the Bezold-Jarisch reflex (BJR), appropriate accommodations were made. The procedure was completed uneventfully.Conclusion. The episode was consistent with a manifestation of the BJR. The patient had a history of neurocardiogenic syncope and a relatively low-volume state, factors prone to the BJR. Overall, lead implantation can still occur safely if preventive measures are employed.

scholarly journals Microstimulation Is a Promising Approach in Achieving Better Lead Placement in Subthalamic Nucleus Deep Brain Stimulation Surgery

2021 ◽  
Vol 12 ◽  
Author(s):  
Lin Shi ◽  
Shiying Fan ◽  
Tianshuo Yuan ◽  
Huaying Fang ◽  
Jie Zheng ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Subthalamic Nucleus ◽  
Brain Stimulation ◽  
Neuronal Firing ◽  
Lead Placement ◽  
Imaging Reconstruction ◽  
Neurophysiological Data ◽  
Lead Location ◽  
Deep Brain Stimulation Surgery ◽  
Deep Brain

Background: The successful application of subthalamic nucleus (STN) deep brain stimulation (DBS) surgery relies mostly on optimal lead placement, whereas the major challenge is how to precisely localize STN. Microstimulation, which can induce differentiating inhibitory responses between STN and substantia nigra pars reticulata (SNr) near the ventral border of STN, has indicated a great potential of breaking through this barrier.Objective: This study aims to investigate the feasibility of localizing the boundary between STN and SNr (SSB) using microstimulation and promote better lead placement.Methods: We recorded neurophysiological data from 41 patients undergoing STN-DBS surgery with microstimulation in our hospital. Trajectories with typical STN signal were included. Microstimulation was applied near the bottom of STN to determine SSB, which was validated by the imaging reconstruction of DBS leads.Results: In most trajectories with microstimulation (84.4%), neuronal firing in STN could not be inhibited by microstimulation, whereas in SNr long inhibition was observed following microstimulation. The success rate of localizing SSB was significantly higher in trajectories with microstimulation than those without. Moreover, results from imaging reconstruction and intraoperative neurological assessments demonstrated better lead location and higher therapeutic effectiveness in trajectories with microstimulation and accurately identified SSB.Conclusion: Microstimulation on microelectrode recording is an effective approach to localize the SSB. Our data provide clinical evidence that microstimulation can be routinely employed to achieve better lead placement.

Operative Technique and Workflow of Deep Brain Stimulation Surgery With Pre-existing Cochlear Implants

2019 ◽  
Vol 19 (2) ◽  
pp. 143-149
Author(s):  
Erik Bolier ◽  
Jessica A Karl ◽  
R Mark Wiet ◽  
Alireza Borghei ◽  
Leo Verhagen Metman ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Cochlear Implants ◽  
Brain Stimulation ◽  
Operative Technique ◽  
Case Reports ◽  
Time Frame ◽  
Lead Placement ◽  
History Of ◽  
Magnetic Resonance Imaging Mri ◽  
Deep Brain

Abstract Background Deep brain stimulation (DBS) surgery in patients with pre-existing cochlear implants (CIs) poses various challenges. We previously reported successful magnetic resonance imaging (MRI)-based, microelectrode recording (MER)-guided subthalamic DBS surgery in a patient with a pre-existing CI. Other case reports have described various DBS procedures in patients with pre-existing CIs using different techniques, leading to varying issues to address. A standardized operative technique and workflow for DBS surgery in the setting of pre-existing CIs is much needed. Objective To provide a standardized operative technique and workflow for DBS lead placement in the setting of pre-existing CIs. Methods Our operative technique is MRI-based and MER-guided, following a workflow involving coordination with a neurotology team to remove and re-implant the internal magnets of the CIs in order to safely perform DBS lead placement, altogether within a 24-h time frame. Intraoperative nonverbal communication with the patient is easily possible using a computer monitor. Results A 65-yr old woman with a 10-yr history of craniocervical dystonia and pre-existing bilateral CIs underwent successful bilateral pallidal DBS surgery at our institution. No merging errors or difficulties in targeting globus pallidus internus were experienced. Also, inactivated CIs do not interfere with MER nor with stimulation, and intraoperative communication with the patient using a computer monitor proved feasible and satisfactory. Conclusion DBS procedures are safe and feasible in patients with pre-existing CIs if precautions are taken following our workflow.

scholarly journals Deep brain stimulation of the ventralis intermedius nucleus for the treatment of essential tremor

2017 ◽  
Vol 42 (videosuppl2) ◽  
pp. V3
Author(s):  
Alexander G. Chartrain ◽  
Ahmed J. Awad ◽  
Jonathan J. Rasouli ◽  
Robert J. Rothrock ◽  
Brian H. Kopell
Keyword(s):  
Deep Brain Stimulation ◽  
Physical Examination ◽  
Essential Tremor ◽  
Brain Stimulation ◽  
Optimal Trajectory ◽  
Lesion Effect ◽  
Lead Placement ◽  
History Of ◽  
Deep Brain ◽  
Stimulation Of

A 59-year-old woman with a 30-year history of essential tremor refractory to medical therapy underwent staged deep brain stimulation of the ventralis intermedius nucleus of the thalamus (VIM). Left-sided lead placement was performed first. Once in the operating room, microelectrode recording (MER) was performed to confirm the appropriate trajectory and identify the VIM border with the ventralis caudalis nucleus. MER was repeated after repositioning 2 mm anteriorly to reduce the likelihood of stimulation-induced paresthesias. Physical examination prior to permanent lead placement demonstrated micro-lesion effect, suggesting optimal trajectory. After implantation of the permanent lead, physical examination showed excellent results.The video can be found here: https://youtu.be/nn3KRdmRCZ4.

scholarly journals Symptomatic, left-sided deep brain stimulation lead edema 6 h after bilateral subthalamic nucleus lead placement

2019 ◽  
Vol 10 ◽  
pp. 68 ◽  
Author(s):  
Jonathan J. Lee ◽  
Bradley Daniels ◽  
Ryan J. Austerman ◽  
Brian D. Dalm
Keyword(s):  
Deep Brain Stimulation ◽  
Subthalamic Nucleus ◽  
Brain Stimulation ◽  
Rare Complication ◽  
Postoperative Changes ◽  
Lead Placement ◽  
History Of ◽  
History Of Parkinson’S Disease ◽  
Deep Brain ◽  
Rule Out

Background: Deep brain stimulation (DBS) lead edema can be a serious, although rare, complication in the postoperative period. Of the few cases that have been reported, the range of presentation has been 33 h–120 days after surgery. Case Description: We report a case of a 75-year-old male with a history of Parkinson’s disease who underwent bilateral placement of subthalamic nucleus DBS leads that resulted in symptomatic, left-sided lead edema 6 h after surgery, which is the earliest reported case. Conclusions: DBS lead edema is noted to be a self-limiting phenomenon. It is critical to recognize the possibility of lead edema as a cause of postoperative encephalopathy even in the acute phase after surgery. Although it is important to rule out other causes of postoperative changes in the patient examination, the recognition of lead edema can help to avoid extraneous diagnostic tests or DBS lead revision or removal.

Other Biological Approaches to OCD

2012 ◽  
Author(s):  
Nicole C. R. McLaughlin ◽  
Benjamin D. Greenberg
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Response To Treatment ◽  
History Of ◽  
Key Issues ◽  
Term Management ◽  
Deep Brain

Interest in psychiatric neurosurgery has waxed and waned since the 1930s. This chapter reviews the history of these methods, with a focus on OCD. This review of lesion procedures and deep brain stimulation includes neuropsychological and neuroimaging research in the context of putative neurocircuitry underlying symptoms and response to treatment. The chapter highlights how an abundance of caution is needed, as well as key issues in long-term management of patients so treated.

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