Assessing the microlesion effect of subthalamic deep brain stimulation surgery with FDG PET

2009 ◽  
Vol 110 (6) ◽  
pp. 1278-1282 ◽  
Author(s):  
Michael Pourfar ◽  
Chengke Tang ◽  
Tanya Lin ◽  
Vijay Dhawan ◽  
Michael G. Kaplitt ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Fdg Pet ◽  
Spatial Covariance ◽  
Electrode Implantation ◽  
Regional Brain ◽  
Pet Scanning ◽  
Ventral Thalamus ◽  
Deep Brain Stimulation Surgery ◽  
Deep Brain

Object The authors investigated whether the insertion of deep brain stimulation electrodes into the subthalamic nucleus can alter regional brain metabolism in the absence of stimulation. Methods Six patients with Parkinson disease (PD) underwent preoperative FDG PET scanning, and again after STN electrode implantation with stimulation turned off. Results Compared with baseline values, glucose utilization was reduced in the postoperative off-stimulation scans in the putamen/globus pallidus and in the ventral thalamus (p < 0.01), and there was increased metabolism in the sensorimotor cortex and cerebellum (p < 0.005). The expression of a specific PD-related spatial covariance pattern measured in the FDG PET data did not change after electrode implantation (p = 0.36), nor was there a significant change in clinical motor ratings (p = 0.44). Differences in PD-related spatial covariance pattern expression among the patients after electrode implantation did, however, correlate with the number of microelectrode recording trajectories placed during surgery (r = –0.82, p < 0.05). Conclusions These findings suggest that electrode implantation can impart a microlesion effect on regional brain function. Nonetheless, these local changes did not cross the threshold of network modulation needed to achieve clinical benefit.

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.

Deep Brain Stimulation Surgery

2012 ◽  
pp. 903-920
Author(s):  
Ryan Uitti ◽  
Yashiko Baba ◽  
Robert Wharen
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Deep Brain Stimulation Surgery ◽  
Deep Brain

scholarly journals iHandU: A Novel Quantitative Wrist Rigidity Evaluation Device for Deep Brain Stimulation Surgery

Sensors ◽  
2020 ◽  
Vol 20 (2) ◽  
pp. 331 ◽  
Author(s):  
Elodie Múrias Lopes ◽  
Maria do Carmo Vilas-Boas ◽  
Duarte Dias ◽  
Maria José Rosas ◽  
Rui Vaz ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Lessons Learned ◽  
Wrist Flexion ◽  
Stimulation Parameters ◽  
Average Accuracy ◽  
Gyroscope Sensor ◽  
Work Done ◽  
Deep Brain Stimulation Surgery ◽  
Deep Brain

Deep brain stimulation (DBS) surgery is the gold standard therapeutic intervention in Parkinson’s disease (PD) with motor complications, notwithstanding drug therapy. In the intraoperative evaluation of DBS’s efficacy, neurologists impose a passive wrist flexion movement and qualitatively describe the perceived decrease in rigidity under different stimulation parameters and electrode positions. To tackle this subjectivity, we designed a wearable device to quantitatively evaluate the wrist rigidity changes during the neurosurgery procedure, supporting physicians in decision-making when setting the stimulation parameters and reducing surgery time. This system comprises a gyroscope sensor embedded in a textile band for patient’s hand, communicating to a smartphone via Bluetooth and has been evaluated on three datasets, showing an average accuracy of 80%. In this work, we present a system that has seen four iterations since 2015, improving on accuracy, usability and reliability. We aim to review the work done so far, outlining the iHandU system evolution, as well as the main challenges, lessons learned, and future steps to improve it. We also introduce the last version (iHandU 4.0), currently used in DBS surgeries at São João Hospital in Portugal.

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