Intraoperative CT verification of electrode localization in DBS surgery in Parkinson's disease

Abstract

Background: Precise and accurate placement of electrodes in DBS surgery is essential in achievement of proper therapeutical effect in movement disorders. Verification of their position in the target is necessary. It can be performed postoperatively. But more convenient for the patient is an intraoperative CT imaging in the operating room. We evaluated the results of DBS electrodes implantation in patients with Parkinson's disease by intraoperative CT. Case series: 21 patients with Parkinson's disease were operated in 2010-2012 in the Military Clinical Hospital in Bydgoszcz, Poland. Standard procedure of electrode implantation was verified by intraoperative CT in operating room. CT scans were fused with preoperative MRI plan of target (STN) and trajectory and accuracy were assessed. Results: Mean differences between positions of tips of electrodes implanted and intended coordinates of targets were: 0.9 mm; 1.6 mm; and 0.8 mm in horizontal line, in vertical line, and in lateral line respectively and remain within the limits of the intraoperative CT resolution. In 1 case the accuracy was not satisfying and replacement of electrodes in one stage surgery was required. Conclusions: Intraoperative CT is a helpful tool in DBS procedures and enables comparison of preoperative plans with the final trajectory and localization of the tip of electrode visualized in CT in appropriate target. It eliminates necessity of post-op verification outside the operating room. All changes can be done during the procedure. It also allows to rule out the intracerebral haematoma caused by implantation.

A Method of Flexible Micro-Wire Electrode Insertion in Rodent for Chronic Neural Recording and a Device for Electrode Insertion

“…After 50 days post implantation, the rat was euthanized. To visualize the implanted microelectrode inside the brain, the rat head was scanned in a micro-CT scanner after perfusion [37]. The x-ray 3D image of the implanted microelectrode inside the brain is shown in Fig.…”

Accurate Deep Brain Stimulation Lead Placement Concurrent With Research Electrocorticography

“…We note that these error measurements were calculated on postoperative images obtained an average of only 6.5 ± 7.9 hours (mean ± SD) after surgery, where patients were scanned in a reclined position, as opposed to the semireclined intraoperative position, which could result in different patterns of pneumocephalus. Compared with results from groups that measure lead error with intraoperative imaging (eg, before cannula removal) or postoperatively after resolution of pneumocephalus, [30][31][32][33][34][35][36][37][38] use of an acute postoperative scan might be expected to result in larger error calculations. These factors, however, would not affect comparison between R-ECoG and non-R-ECoG groups because the average interval to postoperative imaging was not different between the groups.…”

Intraoperative Localization of the Subthalamic Nucleus Using Long-Latency Somatosensory Evoked Potentials

“…A crucial step that contributes toward successful DBS treatment pertain target localization within a specified brain subcortical region. Current methodologies for DBS target localization in PD involve: 1) high‐resolution imaging techniques (CT and MRI including DTI) dealing with preoperative calculation of stereotactic coordinates ; 2) intraoperative microelectrode recordings aimed at determining specific firing patterns, proprioceptive responses to passive movements, and asymmetrical high‐frequency spikes that could be useful in characterizing a potential DBS target .…”