Asymptomatic Transient MRI Signal Changes after Unilateral Deep Brain Stimulation Electrode Implantation for Movement Disorder

Ryu, Stephen I.; Romanelli, Pantaleo; Heit, Gary

doi:10.1159/000077402

Cited by 29 publications

(29 citation statements)

References 18 publications

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“…A follow-up cranial MRI at 3 months after removal of the implants showed partial resolution of these white matter changes along the implant tracts. These findings were similar to asymptomatic white matter changes previously reported with implants for deep brain stimulation [38]. …”

Section: Resultssupporting

confidence: 92%

Encapsulated Cell Biodelivery of Nerve Growth Factor to the Basal Forebrain in Patients with Alzheimer’s Disease

Eriksdotter¹,

Linderoth²,

Lind³

et al. 2012

Dement Geriatr Cogn Disord

135

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Background/Aims: Degeneration of cholinergic neurons in the basal forebrain correlates with cognitive decline in patients with Alzheimer’s disease (AD). Targeted delivery of exogenous nerve growth factor (NGF) has emerged as a potential AD therapy due to its regenerative effects on the basal forebrain cholinergic neurons in AD animal models. Here we report the results of a first-in-man study of encapsulated cell (EC) biodelivery of NGF to the basal forebrain of AD patients with the primary objective to explore safety and tolerability. Methods: This was an open-label, 12-month study in 6 AD patients. Patients were implanted stereotactically with EC-NGF biodelivery devices targeting the basal forebrain. Patients were monitored with respect to safety, tolerability, disease progression and implant functionality. Results: All patients were implanted successfully with bilateral single or double implants without complications or signs of toxicity. No adverse events were related to NGF or the device. All patients completed the study, including removal of implants at 12 months. Positive findings in cognition, EEG and nicotinic receptor binding in 2 of 6 patients were detected. Conclusions: This study demonstrates that surgical implantation and removal of EC-NGF biodelivery to the basal forebrain in AD patients is safe, well tolerated and feasible.

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Section: Resultssupporting

confidence: 92%

Encapsulated Cell Biodelivery of Nerve Growth Factor to the Basal Forebrain in Patients with Alzheimer’s Disease

Eriksdotter¹,

Linderoth²,

Lind³

et al. 2012

Dement Geriatr Cogn Disord

135

View full text Add to dashboard Cite

show abstract

“…There are no Class I data supporting this belief, but it is consonant with our experience, discussed in the literature [15] and supported by the edema surrounding the DBS electrode [16]. An MRI is obtained for planning on the day of the second implantation.…”

Section: Operative Techniquessupporting

confidence: 77%

“…Although this issue has been addressed by others [15] and is supported by MRI findings [16], there is no Class I evidence to support either a staged or simultaneous implantation. Some of the nuances presented here do not therefore apply to centers implanting both sides in a single procedure.…”

Section: Discussionmentioning

confidence: 92%

Some technical nuances for deep brain stimulator implantation

Giller

Jenkins

2015

Interdisciplinary Neurosurgery

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Protocols for deep brain stimulator (DBS) implantation vary significantly among movement disorders centers despite the need to address similar operative problems. The general steps of this procedure are well accepted, but there are many seemingly minor, yet important nuances not extensively discussed in published descriptions. A classification and the details of the nuances adopted by a single institution may therefore be helpful in providing a basis for discussion and comparison. We describe operative nuances adopted at the Georgia Regents Medical Center (GRMC) for DBS implantation that may not be universally employed. The problems of DBS implantation considered here include stereotactic planning, draping, creation and use of the burhole, physiological testing, anchoring of the electrode, financial considerations, and overall technique. Fourteen categories of operative nuances were identified and described in detail. These include the use of specific anatomical relationships for planning, the use of clear and watertight drapes, countersinking of the burhole, the use of gelfoam and tissue glue to seal the burhole, methods to review the entire microelectrode data simultaneously, blinded communication with the patient during macrostimulation, fluoroscopic marking, MRI compatible protection of the electrode tip, financial considerations effecting choice of operative materials, and restriction to a single operator. The majority of these have not been extensively described but may be in use at other centers. The many operative problems arising during DBS implantation can be addressed with specific technical nuances.

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“…Immediate postoperative MRI of asymptomatic DBS patients typically reveals no parenchymal abnormality related to lead implantation [16,17] ; however, Ryu et al [18] described occasional T 2 -weighted signal hyperintensity adjacent to leads in DBS patients imaged 3 weeks to 3 months after surgery. On routine postoperative MRI scans at our institution, we have recently observed several instances of dramatic parenchymal T 2 signal abnormality surrounding recently implanted DBS leads not associated with infection or hemorrhage.…”

mentioning

confidence: 99%

Abnormal T<sub>2</sub>-Weighted MRI Signal Surrounding Leads in a Subset of Deep Brain Stimulation Patients

Englot

Glastonbury

Larson

2011

Stereotact Funct Neurosurg

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Background: Deep brain stimulation (DBS) surgery is a common treatment option for numerous neurological disorders. However, it is not without potential complications, such as hemorrhage and infection. Interestingly, we have observed several instances of abnormal T₂-weighted signal hyperintensity surrounding DBS leads on postoperative MRI that are not associated with hemorrhage or infection. Methods: To better characterize the incidence and timing associated with this finding, we retrospectively reviewed postoperative imaging for all DBS implants performed over 9 years at one institution. Results and Conclusions: Fifteen instances of T₂ signal hyperintensity surrounding DBS leads on postoperative MRI scans were observed across 239 implants (6.3% incidence) in 133 patients. The signal characteristics were most consistent with vasogenic edema, possibly representing an inflammatory response. The finding was typically unilateral, even in patients with simultaneous bilateral lead implants. Most affected patients were asymptomatic, although 3 were symptomatic and 1 experienced marked gait instability that was treated with steroids. T₂ signal abnormality was seen more commonly in scans obtained 3 or more days after surgery than in those collected immediately postoperatively. No differences in age, anatomical target, diagnosis, or number of microelectrode passes were noted between patients with or without T₂ signal. Further research will be needed to explain this curious neuroimaging finding, and to rule out cause for clinical concern.

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Asymptomatic Transient MRI Signal Changes after Unilateral Deep Brain Stimulation Electrode Implantation for Movement Disorder

Cited by 29 publications

References 18 publications

Encapsulated Cell Biodelivery of Nerve Growth Factor to the Basal Forebrain in Patients with Alzheimer’s Disease

Encapsulated Cell Biodelivery of Nerve Growth Factor to the Basal Forebrain in Patients with Alzheimer’s Disease

Some technical nuances for deep brain stimulator implantation

Abnormal T<sub>2</sub>-Weighted MRI Signal Surrounding Leads in a Subset of Deep Brain Stimulation Patients

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