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

Miyagi, Yasushi; Shima, Fumio; Sasaki, Tatsuya

doi:10.3171/jns.2007.107.5.989

Cited by 44 publications

(64 citation statements)

References 9 publications

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“…Shift is typically initiated by intracranial air entry, which may be due to loss of CSF and/or due to equalization of intracranial and atmospheric pressure. 2,16,17 Other causes of shift specific to stereotactic surgery include the deformation of tissue caused by the tip of a rigid electrode during implantation. Although not tested in our study, several reports suggest ways to reduce brain shift.…”

Section: Prevention 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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Section: Prevention 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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“…After a durotomy for the implantation of the second electrode, the equilibrium is established in a mediolateral direction because of air entry from the second side. However, together with this mediolateral equilibration, a significant dorsal (posterior) brain shift occurs (14). According to this mechanism, the effect of brain shift, particularly in a posterior direction, should be more prominent on the second side implanted.…”

Section: █ Discussionmentioning

confidence: 99%

Learning curve in anatomo-electrophysiological correlations in subthalamic nucleus stimulation

Hrabovský¹,

Baláž²,

Bočková³

et al. 2016

Turkish Neurosurgery

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Parkinson's disease and other movement disorders, but not limited to them (4,13). The anatomical target definition based on neuroradiological investigation can be supported by intraoperative microrecording using simultaneously or sequentially implanted intracerebral microelectrodes and intraoperative MATERIAL and METHODS:The trajectories of right (first implanted) and left electrodes were compared in the first 50 patients operated on (Group 1) and the next 50 patients (Group 2). RESULTS:In Group 1, 52% of central trajectories were on the right and 38% on the left; in Group 2, the percentage of central trajectories was 76% on the right and 78% on the left; the difference was statistically significant (p=0.021 and 0.001). The difference in the percentage of posterior trajectories reflecting brain shift between the right and left sides was statistically insignificant in Groups 1 (26% and 28%, p=0.999) and 2 (18% and 12%, p=0.549). The percentage of bilateral central electrodes was 14% and 62% in Groups 1 and 2, respectively. CONCLUSION:The correlation between anatomically planned trajectory and final electrode placement markedly improves with the number of patients. However the significant percentage of patients with final electrode trajectory differing from anatomically planned target supports the use of intraoperative monitoring.

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“…With grid implantation through craniotomy, the brain surface can be photographed and images can be superimposed onto a cortical MRI reconstruction. [15][16][17][18][19][20] Combinations of photography and 2-dimensional radiography have been described, 10 as have linear superpositions using a 3-dimensional visualization system. 9 Contacts under the margins of the craniotomy or placed through burr holes cannot be documented photographically; these contacts are also subject to brain shift, which can be corrected mathematically.…”

Section: Discussionmentioning

confidence: 99%

“…7,8 A linear image fusion, allowing only translations, rotations, scaling, and skewness to align 2 image data sets, might localize the contacts in the wrong position. 9,10 Elastic image fusion algorithms are a relatively new development and are not yet standard in the commercial software used in neurosurgery. In addition to linear translations, they allow local modifications of the image data sets to achieve a better alignment.…”

Section: Discussionmentioning

confidence: 99%

Improved Localization of Implanted Subdural Electrode Contacts on Magnetic Resonance Imaging With an Elastic Image Fusion Algorithm in an Invasive Electroencephalography Recording

Stieglitz

Ayer

Schindler³

et al. 2014

Operative Neurosurgery

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BACKGROUND: Accurate projection of implanted subdural electrode contacts in presurgical evaluation of pharmacoresistant epilepsy cases by invasive electroencephalography is highly relevant. Linear fusion of computed tomography and magnetic resonance images may display the contacts in the wrong position as a result of brain shift effects. OBJECTIVE: A retrospective study in 5 patients with pharmacoresistant epilepsy was performed to evaluate whether an elastic image fusion algorithm can provide a more accurate projection of the electrode contacts on the preimplantation magnetic resonance images compared with linear fusion. METHODS: An automated elastic image fusion algorithm (AEF), a guided elastic image fusion algorithm (GEF), and a standard linear fusion algorithm were used on preoperative magnetic resonance images and postimplantation computed tomography scans. Vertical correction of virtual contact positions, total virtual contact shift, corrections of midline shift, and brain shifts caused by pneumocephalus were measured. RESULTS: Both AEF and GEF worked well with all 5 cases. An average midline shift of 1.7 mm (SD, 1.25 mm) was corrected to 0.4 mm (SD, 0.8 mm) after AEF and to 0.0 mm (SD, 0 mm) after GEF. Median virtual distances between contacts and cortical surface were corrected by a significant amount, from 2.3 mm after linear fusion algorithm to 0.0 mm after AEF and GEF (P < .001). Mean total relative corrections of 3.1 mm (SD, 1.85 mm) after AEF and 3.0 mm (SD, 1.77 mm) after GEF were achieved. The tested version of GEF did not achieve a satisfying virtual correction of pneumocephalus. CONCLUSION: The technique provided a clear improvement in fusion of preimplantation and postimplantation scans, although the accuracy is difficult to evaluate. Improved Localization of Implanted Subdural Electrode Contacts on Magnetic Resonance Imaging With an Elastic Image Fusion Algorithm in an Invasive Electroencephalography RecordingBACKGROUND: Accurate projection of implanted subdural electrode contacts in presurgical evaluation of pharmacoresistant epilepsy cases by invasive electroencephalography is highly relevant. Linear fusion of computed tomography and magnetic resonance images may display the contacts in the wrong position as a result of brain shift effects. OBJECTIVE: A retrospective study in 5 patients with pharmacoresistant epilepsy was performed to evaluate whether an elastic image fusion algorithm can provide a more accurate projection of the electrode contacts on the preimplantation magnetic resonance images compared with linear fusion. METHODS: An automated elastic image fusion algorithm (AEF), a guided elastic image fusion algorithm (GEF), and a standard linear fusion algorithm were used on preoperative magnetic resonance images and postimplantation computed tomography scans. Vertical correction of virtual contact positions, total virtual contact shift, corrections of midline shift, and brain shifts caused by pneumocephalus were measured. RESULTS: Both AEF and GEF worked well with all 5 ca...

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

Cited by 44 publications

References 9 publications

Brain shift during bur hole–based procedures using interventional MRI

Brain shift during bur hole–based procedures using interventional MRI

Learning curve in anatomo-electrophysiological correlations in subthalamic nucleus stimulation

Improved Localization of Implanted Subdural Electrode Contacts on Magnetic Resonance Imaging With an Elastic Image Fusion Algorithm in an Invasive Electroencephalography Recording

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