Deep brain stimulation electrodes may rotate after implantation—an animal study

Abstract

Directional deep brain stimulation (dDBS) electrodes allow to steer the electrical field in a specific direction. When implanted with torque, they may rotate for a certain time after implantation. The aim of this study was to evaluate whether and to which degree leads rotate in the first 24 h after implantation using a sheep brain model. dDBS electrodes were implanted in 14 sheep heads and 3D rotational fluoroscopy (3D-RF) scans were acquired to visualize the orientation of the electrode leads. Electrode leads were clockwise rotated just above the burr holes (180° n = 6, 360° n = 6, 2 controls) and 3D-RF scans were again acquired after 3, 6, 13, 17, and 24 h, respectively. One hundred eighty degree rotated electrodes showed an initial rotation of 83.5° (range: 35.4°–128.3°) and a rotation of 114.0° (range: 57°–162°) after 24 h. With 360° torsion, mean initial rotation was 201° (range: 3.3°–321.4°) and mean rotation after 24 h 215.7° (range 31.9°–334.7°), respectively. Direct postoperative imaging may not be accurate for determining the rotation of dDBS electrodes if torque is present.

Deviation of the Orientation Angle of Direction Deep Brain Stimulation Leads Quantified by Intraoperative Stereotactic X-ray Imaging

“…These results showed as hypothesized by the investigators that independent from biological factors such as brain shift, mechanical manipulation could have a substantial effect on electrode rotation. In addition, neither time course nor the degree of rotation seemed to be predictable [13].…”

“…In addition, depending on the imaging modality and/or the access angle of the lead determination of the rotational angle might be prone to errors [20]. Importantly, one in vivo study suggested that simple mechanical manipulation of the electrode during surgery might be responsible for electrode rotation [13].…”

DiODe v2: Unambiguous and Fully-Automated Detection of Directional DBS Lead Orientation

“…One limitation of our analysis is that the postoperative CT scans and the intraoperative X-rays used for visual confirmation of the correct solution were not performed at the same time. As shown in an animal study [ 9 ], DBS leads may rotate during the first 24 h after implantation if torque is present. However, these changes are not expected to exceed 60° and thus are not likely to have impacted our analysis regarding the 180° ambiguity of the marker artifacts.…”

“…This selection process can be guided by a priori neuroanatomical knowledge [ 3 ], probabilistic sweet spots [ 4 , 5 ] or individual neuroimaging [ 6 ], but detailed information about the lead’s location and orientation with respect to the surrounding anatomy is needed. Previous results showed that the precise placement of a directional lead into the desired orientation is difficult due to lead torsion [ 7 ], which additionally can lead to changes in a lead’s orientation within the first days after implantation [ 8 , 9 , 10 ]. Consecutively, lead orientation needs to be derived from postoperative imaging, and different methods have been proposed for different imaging techniques [ 11 , 12 , 13 ].…”

The Impact of Burr Hole Device and Lead Design on Deep Brain Stimulation Lead Stability in Benchtop and Ovine Models

“…Although the need for translational lead stability relative to an anatomic target for effective DBS has been widely appreciated, [4][5][6][7][8][9][10][11] the advent of directional electrodes highlights a new need for rotational stability. [12][13][14][15] Dembek et al 12 recently found a wide range of angular deviations for 198 leads in 100 patients when they compared rotational lead orientations at implant and postoperatively in a segmented electrode lead from one manufacturer. The researchers found that 41% of the leads studied had deviations of 30 • or greater when using bone cement and a microplate to stabilize the leads.…”