Accuracy of Magnetic Resonance Imaging–Directed Frame-Based Stereotaxis

2011 ◽  
Vol 70 (suppl_1) ◽  
pp. ons114-ons124 ◽  
Author(s):  
Nova B. Thani ◽  
Arul Bala ◽  
Christopher R. P. Lind
Keyword(s):  
Deep Brain Stimulation ◽  
Magnetic Resonance ◽  
Brain Stimulation ◽  
Entry Point ◽  
Mean Deviation ◽  
Guide Tube ◽  
3 Dimensional ◽  
The Mean ◽  
The Brain ◽  
Deep Brain

Abstract BACKGROUND: Accurate placement of a probe to the deep regions of the brain is an important part of neurosurgery. In the modern era, magnetic resonance image (MRI)-based target planning with frame-based stereotaxis is the most common technique. OBJECTIVE: To quantify the inaccuracy in MRI-guided frame-based stereotaxis and to assess the relative contributions of frame movements and MRI distortion. METHODS: The MRI-directed implantable guide-tube technique was used to place carbothane stylettes before implantation of the deep brain stimulation electrodes. The coordinates of target, dural entry point, and other brain landmarks were compared between preoperative and intraoperative MRIs to determine the inaccuracy. RESULTS: The mean 3-dimensional inaccuracy of the stylette at the target was 1.8 mm (95% confidence interval [CI], 1.5-2.1. In deep brain stimulation surgery, the accuracy in the x and y (axial) planes is important; the mean axial inaccuracy was 1.4 mm (95% CI, 1.1-1.8). The maximal mean deviation of the head frame compared with brain over 24.1 ± 1.8 hours was 0.9 mm (95% CI, 0.5-1.1). The mean 3-dimensional inaccuracy of the dural entry point of the stylette was 1.8 mm (95% CI, 1.5-2.1), which is identical to that of the target. CONCLUSION: Stylette positions did deviate from the plan, albeit by 1.4 mm in the axial plane and 1.8 mm in 3-dimensional space. There was no difference between the accuracies at the dura and the target approximately 70 mm deep in the brain, suggesting potential feasibility for accurate planning along the whole trajectory.

A Magnetic Resonance Imaging–Directed Method for Transventricular Targeting of Midline Structures for Deep Brain Stimulation Using Implantable Guide Tubes

2010 ◽  
Vol 66 (suppl_2) ◽  
pp. ons234-ons237 ◽  
Author(s):  
Sadaquate Khan ◽  
Shazia Javed ◽  
Nicholas Park ◽  
Steven S. Gill ◽  
Nikunj K. Patel
Keyword(s):  
Magnetic Resonance Imaging ◽  
Deep Brain Stimulation ◽  
Magnetic Resonance ◽  
Brain Stimulation ◽  
Target Site ◽  
Guide Tube ◽  
Resonance Imaging ◽  
Subcortical Structures ◽  
Ventricular Lead ◽  
Deep Brain

Abstract OBJECTIVE The periventricular gray/periaqueductal gray (PVG/PAG) is a target site for deep brain stimulation for chronic pain. The pedunculopontine nucleus (PPN) is a target for the treatment of axial disturbance in Parkinson's disease. Conventionally, a trajectory lateral to the ventricle is used in targeting deep subcortical structures; however, this limits the number of active contacts that can be placed in these midline targets. To maximize the number of contacts within these targets, a trajectory traversing the ventricles may be used; however, this is avoided because lead placement remains unpredictable with problems including ventricular lead migration and hemorrhage. We describe a novel method for accurate and safe transventricular targeting. METHODS Magnetic resonance imaging is used for visualizing the target structure. A trajectory traversing the lateral ventricle is planned, avoiding blood vessels. The guide tube is inserted through the ventricle to a position short of the target site and its proximal end is fixed. A stylet is inserted in the guide tube with its distal end at the target site. After intraoperative radiological confirmation of placement, the indwelling stylet is removed and the guide tube acts as a port for delivering the stimulating electrode. RESULTS The PVG/PAG matter and the PPN were targeted, taking a transventricular trajectory. We implanted unilateral PVG/PAG matter electrodes in 10 patients and bilateral PPN electrodes in 3 patients. All electrodes were implanted accurately within the desired target with no complications. CONCLUSION The use of an implanted guide tube enables the safe and accurate transventricular targeting of the PVG/PAG matter and the PPN.

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.

Brain shift: an error factor during implantation of deep brain stimulation electrodes

2007 ◽  
Vol 107 (5) ◽  
pp. 989-997 ◽  
Author(s):  
Yasushi Miyagi ◽  
Fumio Shima ◽  
Tomio Sasaki
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Brain Shift ◽  
Mr Images ◽  
Implanted Electrodes ◽  
Error Factor ◽  
Bilateral Surgery ◽  
Second Procedure ◽  
The Brain ◽  
Deep Brain

Object The goal of this study was to focus on the tendency of brain shift during stereotactic neurosurgery and the shift's impact on the unilateral and bilateral implantation of electrodes for deep brain stimulation (DBS). Methods Eight unilateral and 10 bilateral DBS electrodes at 10 nuclei ventrales intermedii and 18 subthalamic nuclei were implanted in patients at Kaizuka Hospital with the aid of magnetic resonance (MR) imaging–guided and microelectrode-guided methods. Brain shift was assessed as changes in the 3D coordinates of the anterior and posterior commissures (AC and PC) with MR images before and immediately after the implantation surgery. The positions of the implanted electrodes, based on the midcommissural point and AC–PC line, were measured both on x-ray films (virtual position) during surgery and the postoperative MR images (actual position) obtained on the 7th day postoperatively. Results Contralateral and posterior shift of the AC and PC were the characteristics of unilateral and bilateral procedures, respectively. The authors suggest the following. 1) The first unilateral procedure elicits a unilateral air invasion, resulting in a contralateral brain shift. 2) During the second procedure in the bilateral surgery, the contralateral shift is reset to the midline and, at the same time, the anteroposterior support by the contralateral hemisphere against gravity is lost due to a bilateral air invasion, resulting in a significant posterior (caudal) shift. Conclusions To note the tendency of the brain to shift is very important for accurate implantation of a DBS electrode or high frequency thermocoagulation, as well as for the prediction of therapeutic and adverse effects of stereotactic surgery.

Avoiding the ventricle: a simple step to improve accuracy of anatomical targeting during deep brain stimulation

2009 ◽  
Vol 110 (6) ◽  
pp. 1283-1290 ◽  
Author(s):  
Ludvic Zrinzo ◽  
Arjen L. J. van Hulzen ◽  
Alessandra A. Gorgulho ◽  
Patricia Limousin ◽  
Michiel J. Staal ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Electrode Placement ◽  
Neurosurgical Procedures ◽  
Electrode Implantation ◽  
Clinical Observations ◽  
Simple Step ◽  
The Mean ◽  
The Impact ◽  
Deep Brain

Object The authors examined the accuracy of anatomical targeting during electrode implantation for deep brain stimulation in functional neurosurgical procedures. Special attention was focused on the impact that ventricular involvement of the electrode trajectory had on targeting accuracy. Methods The targeting error during electrode placement was assessed in 162 electrodes implanted in 109 patients at 2 centers. The targeting error was calculated as the shortest distance from the intended stereotactic coordinates to the final electrode trajectory as defined on postoperative stereotactic imaging. The trajectory of these electrodes in relation to the lateral ventricles was also analyzed on postoperative images. Results The trajectory of 68 electrodes involved the ventricle. The targeting error for all electrodes was calculated: the mean ± SD and the 95% CI of the mean was 1.5 ± 1.0 and 0.1 mm, respectively. The same calculations for targeting error for electrode trajectories that did not involve the ventricle were 1.2 ± 0.7 and 0.1 mm. A significantly larger targeting error was seen in trajectories that involved the ventricle (1.9 ± 1.1 and 0.3 mm; p < 0.001). Thirty electrodes (19%) required multiple passes before final electrode implantation on the basis of physiological and/or clinical observations. There was a significant association between an increased requirement for multiple brain passes and ventricular involvement in the trajectory (p < 0.01). Conclusions Planning an electrode trajectory that avoids the ventricles is a simple precaution that significantly improves the accuracy of anatomical targeting during electrode placement for deep brain stimulation. Avoidance of the ventricles appears to reduce the need for multiple passes through the brain to reach the desired target as defined by clinical and physiological observations.

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 &lt; 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.

scholarly journals The Experiences of Patients with Deep Brain Stimulation in Parkinson’s Disease: Challenges, Expectations, and Accomplishments

2020 ◽  
Vol 49 (1) ◽  
pp. 36
Author(s):  
Özlem İbrahimoğlu ◽  
Sevinc Mersin ◽  
Eda Akyol
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Healthcare Professionals ◽  
Focus Group Interviews ◽  
The Mean ◽  
Group Interviews ◽  
Deep Brain

<p><strong>Objectives. </strong>Deep brain stimulation (DBS) is a safe and effective alternative treatment of some movement disorders such as Parkinson's disease. Although DBS is an effective treatment for Parkinson's disease, because of the necessity of surgical intervention, follow-up and the effects on symptoms, this study was carried out to determine the challenges, expectations and accomplishments of patients with DBS in Parkinson’s disease.</p><p><strong>Materials and Methods. </strong>This qualitative study was carried out at the Neurosurgery Department of a research hospital in Turkey with seven patients who underwent DBS between 2008 and 2018. In the study, the challenges, expectations, and accomplishments of patients were investigated by using three focus group interviews in October 2018.</p><p><strong>Results. </strong>Among the participants, six patients were male, and one patient was female. The mean age of the patients was 56.85}16.48. Three main themes were revealed in the study. These were (1) Reborn; decrease in dependence, sense of accomplishment, enjoyment of life, (2) Prejudice; perceived as severely ill by others and (3) Fear; not being accustomed to the device, loss of device function.</p><p><strong>Conclusion. </strong>The results obtained from this study can be used in the process of adaptation to this process by discussing and evaluating the challenges, expectations and accomplishments of the Parkinson's patient in DBS with healthcare professionals and other patients.</p>

scholarly journals Low frequency deep brain stimulation in the inferior colliculus ameliorates haloperidol-induced catalepsy and reduces anxiety in rats

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0243438
Author(s):  
Hannah Ihme ◽  
Rainer K. W. Schwarting ◽  
Liana Melo-Thomas
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Low Frequency ◽  
Anxiolytic Effect ◽  
Motor Deficits ◽  
Sham Treatment ◽  
Plus Maze ◽  
Aversive Behavior ◽  
The Brain ◽  
Deep Brain

Deep brain stimulation (DBS) of the colliculus inferior (IC) improves haloperidol-induced catalepsy and induces paradoxal kinesia in rats. Since the IC is part of the brain aversive system, DBS of this structure has long been related to aversive behavior in rats limiting its clinical use. This study aimed to improve intracollicular DBS parameters in order to avoid anxiogenic side effects while preserving motor improvements in rats. Catalepsy was induced by systemic haloperidol (0.5mg/kg) and after 60 min the bar test was performed during which a given rat received continuous (5 min, with or without pre-stimulation) or intermittent (5 x 1 min) DBS (30Hz, 200–600μA, pulse width 100μs). Only continuous DBS with pre-stimulation reduced catalepsy time. The rats were also submitted to the elevated plus maze (EPM) test and received either continuous stimulation with or without pre-stimulation, or sham treatment. Only rats receiving continuous DBS with pre-stimulation increased the time spent and the number of entries into the open arms of the EPM suggesting an anxiolytic effect. The present intracollicular DBS parameters induced motor improvements without any evidence of aversive behavior, pointing to the IC as an alternative DBS target to induce paradoxical kinesia improving motor deficits in parkinsonian patients.

scholarly journals Outcomes following deep brain stimulation lead revision or reimplantation for Parkinson’s disease

2019 ◽  
Vol 130 (6) ◽  
pp. 1841-1846 ◽  
Author(s):  
Leonardo A. Frizon ◽  
Sean J. Nagel ◽  
Francis J. May ◽  
Jianning Shao ◽  
Andres L. Maldonado-Naranjo ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Device Failure ◽  
Suboptimal Outcome ◽  
Number Of Patients ◽  
The Mean ◽  
Lead Location ◽  
Deep Brain

OBJECTIVEThe number of patients who benefit from deep brain stimulation (DBS) for Parkinson’s disease (PD) has increased significantly since the therapy was first approved by the FDA. Suboptimal outcomes, infection, or device failure are risks of the procedure and may require lead removal or repositioning. The authors present here the results of their series of revision and reimplantation surgeries.METHODSThe data were reviewed from all DBS intracranial lead removals, revisions, or reimplantations among patients with PD over a 6-year period at the authors’ institution. The indications for these procedures were categorized as infection, suboptimal outcome, and device failure. Motor outcomes as well as lead location were analyzed before removal and after reimplant or revision.RESULTSThe final sample included 25 patients who underwent 34 lead removals. Thirteen patients had 18 leads reimplanted after removal. There was significant improvement in the motor scores after revision surgery among the patients who had the lead revised for a suboptimal outcome (p = 0.025). The mean vector distance of the new lead location compared to the previous location was 2.16 mm (SD 1.17), measured on an axial plane 3.5 mm below the anterior commissure–posterior commissure line. When these leads were analyzed by subgroup, the mean distance was 1.67 mm (SD 0.83 mm) among patients treated for infection and 2.73 mm (SD 1.31 mm) for those with suboptimal outcomes.CONCLUSIONSPatients with PD who undergo reimplantation surgery due to suboptimal outcome may experience significant benefits. Reimplantation after surgical infection seems feasible and overall safe.

Neuroethics

2021 ◽  
pp. 405-420
Author(s):  
Georg Northoff
Keyword(s):  
Deep Brain Stimulation ◽  
Psychiatric Disorders ◽  
Brain Stimulation ◽  
Empirical Data ◽  
Moral Agency ◽  
Ethical Issues ◽  
Spatio Temporal ◽  
The Brain ◽  
Deep Brain

Neuroethics, located at the interface of conceptual and empirical dimensions, carries major implications for psychiatry, such as the neuroscientific basis of ethical concepts as moral agency. Drawing on data in neuroscience, this chapter highlights issues central to psychiatric ethics. First, it addresses a reductionistic model of the brain, often conceived as purely neuronal, and then it discusses empirical data suggesting that the brain’s activity is strongly aligned to its respective social (e.g., relation to others) and ecological (e.g., relation to the environment and nature) contexts; this implies a relational rather than reductionist model. Second, it suggests that self (e.g., the experience or sense of a self) and personhood (e.g., the person as existent independent of experience) must also be understood in such a social and ecological and, therefore, relational and spatio-temporal sense. Ethical concepts like agency, therefore, cannot be limited solely to the person and brain, but must rather be understood in a relational and neuro-ecological/social way. Third, it discusses deep brain stimulation as a treatment that promotes enhancement. In sum, this chapter presents findings in neuroscience that carry major implications for our view of brain, mental features, psychiatric disorders, and ethical issues like agency, responsibility, and enhancement.

Sign in / Sign up

Export Citation Format

Share Document