Does Intraoperative Computed Tomography Obviate the Need for Postoperative Imaging Studies in Deep Brain Stimulation Surgery?

This chapter reviews the case of a patient with Parkinson disease (PD) who experienced a sustained reduction in symptoms following perioperative intracranial hemorrhage (ICH). The patient, a 55-year-old man, elected to receive deep brain stimulation (DBS) after presenting with PD with rest tremor, bradykinesia, and rigidity. During the implantation operation, the patient suffered a small ICH in the left subthalamic nucleus (STN). Subsequently, he reported a significant improvement in right-side symptoms with the DBS device still in the off state. The case is discussed in detail in this chapter and briefly compared with similar cases that have previously been reported. Computed tomography and magnetic resonance imaging studies done shortly after the ICH occurred are also included.

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2.299 THE USEFULLNESS OF INTRAOPERATIVE COMPUTED TOMOGRAPHY FOR DEEP BRAIN STIMULATION

Parkinsonism & Related Disorders ◽

10.1016/s1353-8020(11)70622-8 ◽

2012 ◽

Vol 18 ◽

pp. S140

Author(s):

Y.S. Park ◽

W.C. Kim ◽

H.S. Kim ◽

S.S. Chung

Keyword(s):

Computed Tomography ◽

Deep Brain Stimulation ◽

Brain Stimulation ◽

Intraoperative Computed Tomography ◽

Deep Brain

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Intraoperative Computed Tomography for Registration of Stereotactic Frame in Frame-Based Deep Brain Stimulation

Neurosurgery ◽

10.1093/neuros/opaa361_s163 ◽

2021 ◽

Vol 89 (Supplement_2) ◽

pp. S163-S163

Author(s):

Michael R Jones ◽

Archit B Baskaran ◽

Mark J Nolt ◽

Joshua M Rosenow

Keyword(s):

Computed Tomography ◽

Deep Brain Stimulation ◽

Brain Stimulation ◽

Intraoperative Computed Tomography ◽

Stereotactic Frame ◽

Deep Brain

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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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