Deep brain stimulator implantation in a diagnostic MRI suite: infection history over a 10-year period

Abstract

10,11,16 Precise electrode placement within a selected brain region is necessary to achieve efficacy, which is traditionally done with frame-based or "frameless" neuronavigation-guided stereotaxy supported by invasive physiological testing including microelectrode recording. Physiological methods can be used to mitigate the accuracy limitations of stereotactic methods that use a skull-mounted frame or other external markers for spatial registration of brain structures to preoperatively acquired images. 2The iMRI DBS electrode implantation technique utilizes bur hole-mounted trajectory guides oriented toward targets that are defined intraoperatively. The entire procedure is performed within the bore of an MR magnet, with the patient's head positioned at the rear magnet opening for surgical exposure and at the magnet isocenter for target identification, device alignment, and insertion monitoring. The primary benefits of the iMRI technique are high targeting accuracy, reduced operative time, and an ability to directly confirm electrode placement during the procedure. In contrast to conventional stereotactic methods, the iMRI approach is performed with the patient under general anesthesia and does not require intraoperative testing of motor symptoms. obJective The objective of this study was to assess the incidence of postoperative hardware infection following interventional (i)MRI-guided implantation of deep brain stimulation (DBS) electrodes in a diagnostic MRI scanner. methods A diagnostic 1.5-T MRI scanner was used over a 10-year period to implant DBS electrodes for movement disorders. The MRI suite did not meet operating room standards with respect to airflow and air filtration but was prepared and used with conventional sterile procedures by an experienced surgical team. Deep brain stimulation leads were implanted while the patient was in the magnet, and patients returned 1-3 weeks later to undergo placement of the implantable pulse generator (IPG) and extender wire in a conventional operating room. Surgical site infections requiring the removal of part or all of the DBS system within 6 months of implantation were scored as postoperative hardware infections in a prospective database. resUlts During the 10-year study period, the authors performed 164 iMRI-guided surgical procedures in which 272 electrodes were implanted. Patients ranged in age from 7 to 78 years, and an overall infection rate of 3.6% was found. Bacterial cultures indicated Staphylococcus epidermis (3 cases), methicillin-susceptible Staphylococcus aureus (2 cases), or Propionibacterium sp. (1 case). A change in sterile practice occurred after the first 10 patients, leading to a reduction in the infection rate to 2.6% (4 cases in 154 procedures) over the remainder of the procedures. Of the 4 infections in this patient subset, all occurred at the IPG site. conclUsions Interventional MRI-guided DBS implantation can be performed in a diagnostic MRI suite with an infection risk comparable to that reported for traditional surgical placement techniqu...

Safety of stereotactic laser ablations performed as treatment for glioblastomas in a conventional magnetic resonance imaging suite

“…In contrast to previous studies in which the procedures were performed in the setting of an intraoperative MRI unit, 5,10 in an MRI suite with modified ventilation, 8 or in a staged manner with the probe inserted in the operating room followed by ablation in the MRI suite, 2 our procedures were performed entirely in the setting of an unmodified diagnostic MRI suite. Importantly, all of our patients underwent SLA during which the biopsy forceps or the fiberoptic probes were repeatedly removed, repositioned, and reinserted into the cranium.…”

“…A terminal clean protocol was instituted on the evening prior to the procedure. 8 In brief, this procedure involves temporarily removing all detachable equipment, cleaning lighting and air ducts, and washing all walls, furniture, and equipment. No diagnostic MRI studies were performed after the cleaning prior to the procedure.…”

Comparison of Awake and Asleep Deep Brain Stimulation for Parkinson’s Disease: A Detailed Analysis Through Literature Review

“…They also pointed out that awake DBS cohorts had a significantly greater decrease in stimulation‐related side effects as measured by the UPDRS IV off‐medication score (78.4% awake vs. 59.7% asleep, p = 0.022) . For MRI‐guided DBS surgeries, Martin et al reported their incidence of hardware infections from iMRI‐guided DBS electrode implantations using a diagnostic MRI scanner in a radiology suite over a ten‐year period . The authors performed 164 iMRI‐guided surgical procedures in which 272 electrodes were implanted.…”

Hemorrhage Detection and Incidence during Magnetic Resonance-Guided Deep Brain Stimulator Implantations

“…The suite contained an in-room monitor and was treated as an OR environment (no personnel was allowed to enter without appropriate surgical attire and strict adherence to sterile technique), although it did not meet OR standards for air turnover and filtration [12]. MR imaging is performed prior to, during, and following the surgical procedure and is detailed in Table 1 of Larson et al [7].…”

“…Recently, the infection profile in a series of 164 patients was reported and demonstrated acceptable rates even in a conventional (nonoperating room) MR scanner setting [12]. Hemorrhage rates for these types of procedures, however, have not been established.…”