Pneumocephalus in subthalamic deep brain stimulation for Parkinson’s disease: a comparison of two different surgical techniques considering factors conditioning brain shift and target precision

Piacentino, Massimo; Beggio, Giacomo; Rustemi, Oriela; Zambon, Giampaolo; Pilleri, Manuela; Raneri, Fabio

doi:10.1007/s00701-020-04635-9

Cited by 14 publications

(18 citation statements)

References 27 publications

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“…In addition, variable pneumocephalus volumes have been reported, as shown in select studies undergoing awake DBS (Table 4). 22,23,25,26,28,29 Mean pneumocephalus volumes spanned from 2.1 to 20.8 cm 3 in these studies, with our study's mean volume of 12.8 cm 3 within the middle of this range. In the 8 patients of our study presenting with volumes between 20 and 30 cm 3 , the number of MER passes and radial error was not increased relative to the remaining cohort.…”

Section: Discussionsupporting

confidence: 55%

“…Pneumocephalus is a cause of brain shift in DBS, but its resulting clinical impact is debated. Previous studies are conflicting with few citing an association between lower pneumocephalus volumes and smaller radial error 22 and with others reporting no association. 21,23,24 To date, pneumocephalus has not been correlated with increased operative time, postoperative complications, or increased postoperative Unified Parkinson Disease Rating Scale measurements.…”

Section: Discussionmentioning

confidence: 93%

“…30 This may be due to the fact that not all patients' optimal lead placement can be determined by anatomy alone. 23 20.78 ± 11.63 87 Leksell frame Jin et al 2020 25 12.25 ± 13.76 95 ROSA Krauss et al 2021 28 1.7 ± 2.9 49 Frame-based Piacentino et al 2021 22 10. No SD reported.…”

Section: Discussionmentioning

confidence: 99%

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Frameless Robotic-Assisted Deep Brain Stimulation With the Mazor Renaissance System

Liang

Ginalis

Jani

et al. 2021

Operative Neurosurgery

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BACKGROUND: Robotic-assisted stereotactic systems for deep brain stimulation (DBS) have recently gained popularity because of their abilities to automate arduous human error-prone steps for lead implantation. Recent DBS literature focuses on frame-based robotic platforms, but little has been reported on frameless robotic approaches, specifically the Food and Drug Administration-approved Mazor Renaissance Guidance System (Mazor Robotics Ltd). OBJECTIVE: To present an initial case series for patients undergoing awake DBS with the Mazor Renaissance Guidance System and evaluate operative variables and stereotactic accuracy. METHODS: Retrospective data collection at a single institution was conducted for an initial 35 consecutive patients. Patient demographics and operative variables, including case times, microelectrode recording passes, and postoperative complications, were obtained by chart review. Implant accuracy was evaluated through measuring radial and vector (x, y) errors using the Mazor software. Pneumocephalus volumes were calculated using immediate postoperative T1-weighted MRI scans. RESULTS: Total operating room (245 ± 5.5 min) and procedural (179 ± 4.7) times were comparable with previous awake DBS literature. The radial error for center tract implants was 1.3 ± 0.1 mm, with smaller error in the first (1.1 ± 0.2) vs second (1.7 ± 0.3) implants of bilateral DBS (P = .048). Vector error analysis demonstrated larger shifts posteriorly for first implants and medially for second implants. Pneumocephalus volumes (12.4 ± 2.2 cm 3 ) were not associated with increased microelectrode recording passes, radial error, or complications. CONCLUSION: Frameless robotic-assisted DBS is a safe and efficient new technology that has been easily adopted into the workflow at our institution.

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Section: Discussionsupporting

confidence: 55%

Section: Discussionmentioning

confidence: 93%

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Frameless Robotic-Assisted Deep Brain Stimulation With the Mazor Renaissance System

Liang

Ginalis

Jani

et al. 2021

Operative Neurosurgery

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“…As a consequence, longer operative lengths are thought to come at a cost of greater amounts of pneumocephalus. To counteract further air accumulation over time, many centers adopted different strategies like the use of burr hole sealants (like brin glue or bone wax), reducing burr hole diameter, and direct dural puncture to reduce CSF egress [20,21,22]. Yet, although some studies reported a decrease in air in ow, such approaches did not prevent pneumocephalus from forming [14,22].…”

Section: Discussionmentioning

confidence: 99%

MER Use and Prolonged Surgical Duration May Not Be Risk Factors for Pneumocephalus Formation During DBS

Iess

Bonomo

Levi

et al. 2022

Preprint

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Purpose: Although only recently directional leads have proven their potential to compensate for sub-optimally placed electrodes, optimal lead positioning remains the most critical factor in degerming Deep Brain Stimulation (DBS) outcome. Pneumocephalus is a recognized source of error, but the factors that contribute to its formation are still a matter of debate. Among these, operative time is one of the most controversial. Because cases of DBS performed with Microelectrode Recordings (MER) are affected by a significant increase in surgical length, it is useful to test for a difference in volumes of air in groups of patients who underwent MER during DBS and those who did not.Methods: 73 and 21 patients who underwent DBS from two different Institutes were analyzed for the presence of postoperative pneumocephalus. The volumes of subdural air of patients who underwent the procedure with the use of microelectrode recordings were compared with those who underwent simple image-guided placement using the Mann-Whitney-U test. A correlation was also tested between surgical operative length and volume of air in a subset of patients. Results: The volumes of air of cases in which MER were utilized were not statistically different from those performed without (p= 0.292). In a similar manner, surgical duration did not predict air volume. Side of surgery (monolateral vs. bilateral) also failed to demonstrate a statistically significant difference (p= 0.075), as well as age.Conclusion: operative time is probably not a significant parameter influencing pneumocephalus’ formation.

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“…In brief, the modified procedure in our center is a beneficial improvement for DBS surgery to avoid CSF loss and reduce brain shift without increased operative complications. Recently, DBS under general anesthesia and DBS with different stimulative targets for multiple disorders have been performed in an increasing number of experienced neurosurgical centers, and CSF loss and brain shift have become topics of concern in DBS surgery ( 22 ). The modified procedure provides the chance of DBS under general anesthesia and DBS with different stimulative targets to complete electrode implantation as a surgical plan.…”

Section: Discussionmentioning

confidence: 99%

A Modified Dura Puncture Procedure to Reduce Brain Shift in Deep Brain Stimulation Surgery: One Institution's Experience

Xiang

Wang

et al. 2022

Front. Neurol.

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ObjectiveThe therapeutic effect of deep brain stimulation (DBS) surgery mainly depends on the accuracy of electrode placement and the reduction in brain shift. Among the standard procedures, cerebrospinal fluid (CSF) loss or pneumocephalus caused by dura incision (DI) is thought to be the main reason for brain shift and inaccuracy of electrode placement. In the current study, we described a modified dura puncture (DP) procedure to reduce brain shift and compare it with the general procedure of DBS surgery in terms of electrode placement accuracy.Materials and MethodsWe retrospectively analyzed a series of 132 patients who underwent DBS surgery in Wuhan Union Hospital from December 2015 to April 2021. According to the different surgery procedures, patients were classified into two cohorts: the DI group (DI cohort) had 49 patients who receive the general procedure, and the DP group (DP cohort) had 83 patients who receive the modified procedure. Postoperative pneumocephalus volume (PPV) and CSF loss volume, electrode fusion error (EFE), and trajectory number were calculated. Meanwhile, intraoperative electrophysiological signal length (IESL), electrode implantation duration, and other parameters were analyzed.ResultsIn the current study, we introduced an improved electrode implantation procedure for DBS surgery named the DP procedure. Compared with the general DI cohort (n = 49), the modified DP cohort (n = 83) had a shorter electrode implantation duration (p < 0.0001), smaller PPV, lower CSF leakage volume (p < 0.0001), and smaller EFE (p < 0.0001). There was no significant difference in IESL (p > 0.05) or adverse events (perioperative cerebral haematoma, skin erosion, epilepsy, p > 0.05) between the two cohorts.ConclusionThe DP procedure is a modified procedure that can reduce brain shift and ensure implantation accuracy during DBS surgery without adverse events.

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Pneumocephalus in subthalamic deep brain stimulation for Parkinson’s disease: a comparison of two different surgical techniques considering factors conditioning brain shift and target precision

Cited by 14 publications

References 27 publications

Frameless Robotic-Assisted Deep Brain Stimulation With the Mazor Renaissance System

Frameless Robotic-Assisted Deep Brain Stimulation With the Mazor Renaissance System

MER Use and Prolonged Surgical Duration May Not Be Risk Factors for Pneumocephalus Formation During DBS

A Modified Dura Puncture Procedure to Reduce Brain Shift in Deep Brain Stimulation Surgery: One Institution's Experience

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