scholarly journals O-Arm Navigated Frameless and Fiducial-Less Deep Brain Stimulation

2020 ◽  
Vol 10 (10) ◽  
pp. 683
Author(s):  
David Krahulík ◽  
Martin Nevrlý ◽  
Pavel Otruba ◽  
Jan Bardoň ◽  
Lumír Hrabálek ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Preoperative Planning ◽  
Total Error ◽  
Microelectrode Recording ◽  
Radial Error ◽  
Test Stimulation ◽  
Vector Error ◽  
Multiple Cell ◽  
Deep Brain

Object: Deep brain stimulation (DBS) is a very useful procedure for the treatment of idiopathic Parkinson’s disease (PD), essential tremor, and dystonia. The authors evaluated the accuracy of the new method used in their center for the placing of DBS electrodes. Electrodes are placed using the intraoperative O-arm™ (Medtronic)-controlled frameless and fiducial-less system, Nexframe™ (Medtronic). Accuracy was evaluated prospectively in eleven consecutive PD patients (22 electrodes). Methods: Eleven adult patients with PD were implanted using the Nexframe system without fiducials and with the intraoperative O-arm (Medtronic) system and StealthStation™ S8 navigation (Medtronic). The implantation of DBS leads was performed using multiple-cell microelectrode recording, and intraoperative test stimulation to determine thresholds for stimulation-induced adverse effects. The accuracy was checked in three different steps: (1) using the intraoperative O-arm image and its fusion with preoperative planning, (2) using multiple-cell microelectrode recording and counting the number of microelectrodes with the signal of the subthalamic nucleus (STN) and finally, (3) total error was calculated according to a postoperative CT control image fused to preoperative planning. Results: The total error of the procedure was 1.79 mm; the radial error and the vector error were 171 mm and 163 mm. Conclusions: Implantation of DBS electrodes using an O-arm navigated frameless and fiducial-less system is a very useful and technically feasible procedure with excellent patient toleration with experienced Nexframe users. The accuracy of the method was confirmed at all three steps, and it is comparable to other published results.

Clinical outcomes of asleep vs awake deep brain stimulation for Parkinson disease

Neurology ◽  
2017 ◽  
Vol 89 (19) ◽  
pp. 1944-1950 ◽  
Author(s):  
Matthew A. Brodsky ◽  
Shannon Anderson ◽  
Charles Murchison ◽  
Mara Seier ◽  
Jennifer Wilhelm ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Deep Brain Stimulation ◽  
Parkinson Disease ◽  
Brain Stimulation ◽  
Electrode Placement ◽  
Microelectrode Recording ◽  
Imaging Guidance ◽  
Motor Outcomes ◽  
Deep Brain

Objective:To compare motor and nonmotor outcomes at 6 months of asleep deep brain stimulation (DBS) for Parkinson disease (PD) using intraoperative imaging guidance to confirm electrode placement vs awake DBS using microelectrode recording to confirm electrode placement.Methods:DBS candidates with PD referred to Oregon Health & Science University underwent asleep DBS with imaging guidance. Six-month outcomes were compared to those of patients who previously underwent awake DBS by the same surgeon and center. Assessments included an “off”-levodopa Unified Parkinson’s Disease Rating Scale (UPDRS) II and III, the 39-item Parkinson's Disease Questionnaire, motor diaries, and speech fluency.Results:Thirty participants underwent asleep DBS and 39 underwent awake DBS. No difference was observed in improvement of UPDRS III (+14.8 ± 8.9 vs +17.6 ± 12.3 points, p = 0.19) or UPDRS II (+9.3 ± 2.7 vs +7.4 ± 5.8 points, p = 0.16). Improvement in “on” time without dyskinesia was superior in asleep DBS (+6.4 ± 3.0 h/d vs +1.7 ± 1.2 h/d, p = 0.002). Quality of life scores improved in both groups (+18.8 ± 9.4 in awake, +8.9 ± 11.5 in asleep). Improvement in summary index (p = 0.004) and subscores for cognition (p = 0.011) and communication (p < 0.001) were superior in asleep DBS. Speech outcomes were superior in asleep DBS, both in category (+2.77 ± 4.3 points vs −6.31 ± 9.7 points (p = 0.0012) and phonemic fluency (+1.0 ± 8.2 points vs −5.5 ± 9.6 points, p = 0.038).Conclusions:Asleep DBS for PD improved motor outcomes over 6 months on par with or better than awake DBS, was superior with regard to speech fluency and quality of life, and should be an option considered for all patients who are candidates for this treatment.Clinicaltrials.gov identifier:NCT01703598.Classification of evidence:This study provides Class III evidence that for patients with PD undergoing DBS, asleep intraoperative CT imaging–guided implantation is not significantly different from awake microelectrode recording–guided implantation in improving motor outcomes at 6 months.

scholarly journals 218 Target Selection for Deep Brain Stimulation in Children with Secondary Dystonia Utilizing Temporary Depth Electrodes for Stimulation and Chronic Recording

Neurosurgery ◽  
2017 ◽  
Vol 64 (CN_suppl_1) ◽  
pp. 259-259
Author(s):  
Richard Aaron Robison ◽  
Diana Ferman ◽  
Mark A Liker ◽  
Terrence Sanger
Keyword(s):  
Deep Brain Stimulation ◽  
Beneficial Effect ◽  
Brain Stimulation ◽  
Single Unit ◽  
Response To Therapy ◽  
Rapid Improvement ◽  
Secondary Dystonia ◽  
Test Stimulation ◽  
Depth Electrodes ◽  
Deep Brain

Abstract INTRODUCTION The optimal target for deep brain stimulation (DBS) treatment in children with secondary dystonia is not known, and the target may vary depending on the etiology and anatomic distribution of injury in each child. We present a new technique for determining optimal neuro-anatomical targets in these patients. METHODS Up to ten depth electrodes are implanted in each child in multiple brain regions, including bilateral STN, GPi, and the VLa (Vo), VLp (Vim) and VPL nuclei of the thalamus. Each electrode had both high-impedance micro contacts to identify single unit firing and macro contacts for identifying local field potentials and for performing test stimulation. Children were monitored for up to one week with continuous recording from all electrodes and intermittent test stimulation at bilateral contact pairs. RESULTS >No single consistent pattern of abnormality was found. Most often, single-unit recording showed high firing rates in GPi, and dystonic movement correlated with activity VLa or VLp. The optimal stimulation target varied between children, with rapid improvement of dystonic postures during stimulation in either VLa, VLp or VPL. Stimulation of STN caused resolution of spasms during sleep in one child. Stimulation in GPi did not produce an immediate effect during the recording period, consistent with known latency of treatment effect. All of the children were implanted with up to 4 permanent stimulation leads connected to implanted pulse generators. Preliminary clinical observations show significant beneficial effect in all children. CONCLUSION This new method of DBS targeting identified targets that varied between children. Early response to therapy suggests a beneficial effect that exceeds what would be expected for GPi stimulation alone. This technique may increase the effectiveness of DBS in secondary dystonia and may allow application to a broader range of conditions in children not previously known to respond to stimulation.

scholarly journals Pediatric Deep Brain Stimulation Using Awake Recording and Stimulation for Target Selection in an Inpatient Neuromodulation Monitoring Unit

2018 ◽  
Vol 8 (7) ◽  
pp. 135 ◽  
Author(s):  
Terence D. Sanger ◽  
Mark Liker ◽  
Enrique Arguelles ◽  
Ruta Deshpande ◽  
Arash Maskooki ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Basal Ganglia ◽  
Brain Stimulation ◽  
Rating Scale ◽  
Target Selection ◽  
Test Stimulation ◽  
Depth Electrodes ◽  
A New Technique ◽  
High Degree ◽  
Deep Brain

Deep brain stimulation (DBS) for secondary (acquired, combined) dystonia does not reach the high degree of efficacy achieved in primary (genetic, isolated) dystonia. We hypothesize that this may be due to variability in the underlying injury, so that different children may require placement of electrodes in different regions of basal ganglia and thalamus. We describe a new targeting procedure in which temporary depth electrodes are placed at multiple possible targets in basal ganglia and thalamus, and probing for efficacy is performed using test stimulation and recording while children remain for one week in an inpatient Neuromodulation Monitoring Unit (NMU). Nine Children with severe secondary dystonia underwent the NMU targeting procedure. In all cases, 4 electrodes were implanted. We compared the results to 6 children who had previously had 4 electrodes implanted using standard intraoperative microelectrode targeting techniques. Results showed a significant benefit, with 80% of children with NMU targeting achieving greater than 5-point improvement on the Burke–Fahn–Marsden Dystonia Rating Scale (BFMDRS), compared with 50% of children using intraoperative targeting. NMU targeting improved BFMDRS by an average of 17.1 whereas intraoperative targeting improved by an average of 10.3. These preliminary results support the use of test stimulation and recording in a Neuromodulation Monitoring Unit (NMU) as a new technique with the potential to improve outcomes following DBS in children with secondary (acquired) dystonia. A larger sample size will be needed to confirm these results.

A literature review of magnetic resonance imaging sequence advancements in visualizing functional neurosurgery targets

2021 ◽  
pp. 1-14
Author(s):  
Alexandre Boutet ◽  
Aaron Loh ◽  
Clement T. Chow ◽  
Alaa Taha ◽  
Gavin J. B. Elias ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
White Matter ◽  
Globus Pallidus ◽  
Subthalamic Nucleus ◽  
Brain Stimulation ◽  
Preoperative Planning ◽  
Imaging Techniques ◽  
Anatomical Landmarks ◽  
Functional Neurosurgery ◽  
Deep Brain

OBJECTIVE Historically, preoperative planning for functional neurosurgery has depended on the indirect localization of target brain structures using visible anatomical landmarks. However, recent technological advances in neuroimaging have permitted marked improvements in MRI-based direct target visualization, allowing for refinement of “first-pass” targeting. The authors reviewed studies relating to direct MRI visualization of the most common functional neurosurgery targets (subthalamic nucleus, globus pallidus, and thalamus) and summarize sequence specifications for the various approaches described in this literature. METHODS The peer-reviewed literature on MRI visualization of the subthalamic nucleus, globus pallidus, and thalamus was obtained by searching MEDLINE. Publications examining direct MRI visualization of these deep brain stimulation targets were included for review. RESULTS A variety of specialized sequences and postprocessing methods for enhanced MRI visualization are in current use. These include susceptibility-based techniques such as quantitative susceptibility mapping, which exploit the amount of tissue iron in target structures, and white matter attenuated inversion recovery, which suppresses the signal from white matter to improve the distinction between gray matter nuclei. However, evidence confirming the superiority of these sequences over indirect targeting with respect to clinical outcome is sparse. Future targeting may utilize information about functional and structural networks, necessitating the use of resting-state functional MRI and diffusion-weighted imaging. CONCLUSIONS Specialized MRI sequences have enabled considerable improvement in the visualization of common deep brain stimulation targets. With further validation of their ability to improve clinical outcomes and advances in imaging techniques, direct visualization of targets may play an increasingly important role in preoperative planning.

The Impact of Microelectrode Recording on Lead Location in Deep Brain Stimulation for the Treatment of Movement Disorders

2019 ◽  
Vol 132 ◽  
pp. e487-e495
Author(s):  
Ryan B. Kochanski ◽  
Sander Bus ◽  
Bledi Brahimaj ◽  
Alireza Borghei ◽  
Kristen L. Kraimer ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Movement Disorders ◽  
Microelectrode Recording ◽  
Lead Location ◽  
The Impact ◽  
Deep Brain
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