Assessment of Brain Shift Related to Deep Brain Stimulation Surgery

Khan, Muhammad Faisal; Mewes, Klaus; Gross, Robert E.; Škrinjar, Oskar

doi:10.1159/000108588

Cited by 162 publications

(119 citation statements)

References 50 publications

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“…ClearPoint uses real-time MRI to perform target selection and monitor lead placement; it does not rely on MR images obtained preoperatively, which cannot account for intraoperative brain shift due to pneumocephalus, or CT images obtained intraoperatively, which must be fused with preoperative image sets and are therefore subject to potential fusion errors. 13,14 It therefore has the advantage of detecting lead placement errors as well as other intraoperative complications such as hemorrhages in real time, with shorter operative times than awake surgery. Finally, because iMRI DBS can be safely done under general anesthesia and does not require withholding of parkinsonian medications, it may broaden the accessibility to those who might not otherwise be able to tolerate awake surgery.…”

Section: Summary Of Resultsmentioning

confidence: 99%

Clinical outcomes using ClearPoint interventional MRI for deep brain stimulation lead placement in Parkinson’s disease

Ostrem

Ziman

Galifianakis

et al. 2016

JNS

124

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(DBS) has been shown to be a highly effective treatment option for medicationrefractory Parkinson's disease (PD) patients experiencing motor fluctuations and dyskinesia. 5,15,18,21,22,26,31 Clinical outcomes with DBS are critically dependent on the exact lead placement in the intended brain target (dorsal lateral subthalamic nucleus [STN] or posterior [motor] area of the internal globus pallidus [GPi]), but surgical methods to achieve acceptable placement are not standardized. The traditional method for DBS lead implantation involves the use of preoperative brain images registered in a stereotactic coordinate system, and physiological localization using microelectrode-guided mapping of the target regions while patients are awake.28 This method poses challenges when patients are not able to tolerate and/or cooperate with awake surgery (severe "off" medication symptoms, anxiety, pain).Recently a new method has been developed for implan- obJective The ClearPoint real-time interventional MRI-guided methodology for deep brain stimulation (DBS) lead placement may offer advantages to frame-based approaches and allow accurate implantation under general anesthesia. In this study, the authors assessed the safety and efficacy of DBS in Parkinson's disease (PD) using this surgical method. methods This was a prospective single-center study of bilateral DBS therapy in patients with advanced PD and motor fluctuations. Symptom severity was evaluated at baseline and 12 months postimplantation using the change in Unified Parkinson's Disease Rating Scale (UPDRS) Part III "off" medication score as the primary outcome variable. results Twenty-six PD patients (15 men and 11 women) were enrolled from 2010 to 2013. Twenty patients were followed for 12 months (16 with a subthalamic nucleus target and 4 with an internal globus pallidus target). The mean UPDRS Part III "off" medication score improved from 40.75 ± 10.9 to 24.35 ± 8.8 (p = 0.001). "On" medication time without troublesome dyskinesia increased 5.2 ± 2.6 hours per day (p = 0.0002). UPDRS Parts II and IV, total UPDRS score, and dyskinesia rating scale "on" medication scores also significantly improved (p < 0.01). The mean levodopa equivalent daily dose decreased from 1072.5 ± 392 mg to 828.25 ± 492 mg (p = 0.046). No significant cognitive or mood declines were observed. A single brain penetration was used for placement of all leads, and the mean targeting error was 0.6 ± 0.3 mm. There were 3 serious adverse events (1 DBS hardware-related infection, 1 lead fracture, and 1 unrelated death). coNclusioNs DBS leads placed using the ClearPoint interventional real-time MRI-guided method resulted in highly accurate lead placement and outcomes comparable to those seen with frame-based approaches.Clinical trial registration no.: NCT00792532 (clinicaltrials.gov)

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Section: Summary Of Resultsmentioning

confidence: 99%

Clinical outcomes using ClearPoint interventional MRI for deep brain stimulation lead placement in Parkinson’s disease

Ostrem

Ziman

Galifianakis

et al. 2016

JNS

124

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“…The magnitude of the shift throughout the brain has been reported to have a significant range. Several studies have shown that shift in deep structures ranges from 0 to 4 mm 8,13 and on the surface can be more than 10 mm. 8,9,28 One study demonstrated brain shift toward the direction of gravity of approximately 1 mm without a cranial opening even being performed, merely due to position.…”

Section: Discussionmentioning

confidence: 99%

“…This is similar to other reported magnitudes of shift using different methodologies. 8,9,13,29 These include studies that show shift in the deep structures ranges from 0 to 4 mm. 8,13 On the surface we report a range of shift from 0 to 10 mm.…”

Section: Magnitude and Quantification Of Shiftmentioning

confidence: 99%

Brain shift during bur hole–based procedures using interventional MRI

Ivan¹,

Yarlagadda

Saxena

et al. 2014

JNS

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Object. Brain shift during minimally invasive, bur hole-based procedures such as deep brain stimulation (DBS) electrode implantation and stereotactic brain biopsy is not well characterized or understood. We examine shift in various regions of the brain during a novel paradigm of DBS electrode implantation using interventional imaging throughout the procedure with high-field interventional MRI.Methods. Serial MR images were obtained and analyzed using a 1.5-T magnet prior to, during, and after the placement of DBS electrodes via frontal bur holes in 44 procedures. Three-dimensional coordinates in MR space of unique superficial and deep brain structures were recorded, and the magnitude, direction, and rate of shift were calculated. Measurements were recorded to the nearest 0.1 mm.Results. Shift ranged from 0.0 to 10.1 mm throughout all structures in the brain. The greatest shift was seen in the frontal lobe, followed by the temporal and occipital lobes. Shift was also observed in deep structures such as the anterior and posterior commissures and basal ganglia; shift in the pallidum and subthalamic region ipsilateral to the bur hole averaged 0.6 mm, with 9% of patients having over 2 mm of shift in deep brain structures. Small amounts of shift were observed during all procedures; however, the initial degree of shift and its direction were unpredictable.Conclusions. Brain shift is continual and unpredictable and can render traditional stereotactic targeting based on preoperative imaging inaccurate even in deep brain structures such as those used for DBS. This article contains some figures that are displayed in color on line but in black-and-white in the print edition.M. E. Ivan et al. 150J Neurosurg / Volume 121 / July 2014 pressure) or to mechanical force on the brain resulting from the intracranial passage of guidance catheters. Methods Patient Selection and DemographicsA total of 39 patients underwent 47 consecutive operations for implantation of a deep brain stimulator for either Parkinson's disease (PD) or dystonia at the University of California, San Francisco (UCSF) Medical Center. These patients underwent unilateral or bilateral placement of their DBS electrodes via a bur hole procedure. Table 1 shows the patient population, procedure, location, target, and disease process. Three surgeries were excluded from the analysis. One patient was intentionally moved between MRI sequences, invalidating the methodology used to assess brain shift. In 2 additional cases, data were analyzed but the control values for fixed points in the cranium were above our acceptable threshold (> 0.5 mm, see below). Therefore, 44 separate operations were included in this study. Six patients were operated on twice either due to staged unilateral placement of stimulators (5 patients) or replacement of stimulators after infection (1 patient). The average age at the time of surgery was 58 ± 13 years old, and 48% of the patients were female. Fifteen patients had unilateral stimulator placement and 29 had bilateral placement. The target was t...

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“…Electrode functionality was tested 2 weeks after surgery in all patients Table 2 Lead 6 Note.-Mean radial error was 0.7 mm 6 0.4 and the mean trajectory error was 0.5 mm 6 0.4. A, Axial three-dimensional T1-weighted imaging performed after administration of gadolinium chelate and after a grid was placed on the scalp to plan an entry site that avoided overlying cortical veins and to plan a trajectory that avoided the ventricles and deep sulci.…”

Section: Resultsmentioning

confidence: 99%

Interventional MR Imaging for Deep-Brain Stimulation Electrode Placement

et al. 2016

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Purpose:To investigate the safety and targeting errors of deep-brain stimulation (DBS) electrodes placed under interventional magnetic resonance (MR) imaging, which allows near real-time anatomic placement without physiologic mapping. Materials and Methods:Retrospectively evaluated were 10 consecutive patients (five women, five men) with a mean age of 59.9 years (age range, 17-79 years). These patients underwent interventional MR imaging-guided DBS placement for movement disorders from September 2013 to August 2014 for placement of 19 DBS electrodes in cases where traditional frame-based surgery may be challenging because of the following: dystonia resulting in difficulty in placing the patients in frame, patient's inability or unwillingness to tolerate awake surgery, or anatomic anomaly or variant that could increase the risk of bleeding from microelectrode mapping. Outcomes measured included perioperative hemorrhage, death, and stroke, and electrode functionality assessed at 2 weeks after the operation. In addition, the mean radial error and mean trajectory error were calculated. Results:No intraoperative neurologic complications (n = 10 [95% confidence interval: 0%, 31%]) were observed. One patient developed aspiration pneumonia in the postoperative period. Mean radial error was 0.7 mm 6 0.4 (standard deviation) and mean trajectory error was 0.5 mm 6 0.4. All leads delivered clinically effective stimulation. Conclusion:Interventional MR imaging-guided DBS electrode placement may be a safe and effective alternative to conventional frame-based surgery in well-selected patients.q RSNA, 2016

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Assessment of Brain Shift Related to Deep Brain Stimulation Surgery

Cited by 162 publications

References 50 publications

Clinical outcomes using ClearPoint interventional MRI for deep brain stimulation lead placement in Parkinson’s disease

Clinical outcomes using ClearPoint interventional MRI for deep brain stimulation lead placement in Parkinson’s disease

Brain shift during bur hole–based procedures using interventional MRI

Interventional MR Imaging for Deep-Brain Stimulation Electrode Placement

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