Temporal Stability of Lead Orientation in Directional Deep Brain Stimulation

Dembek, Till A.; Asendorf, Adrian L; Wirths, Jochen; Barbe, Michael T.; Visser‐Vandewalle, Veerle; Treuer, Harald

doi:10.1159/000510883

Cited by 16 publications

(19 citation statements)

References 22 publications

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“…We provide evidence for comparable results between GUIDE XT™ and the protocol offered in Lead-DBS. As demonstrated by two recent studies using CT and rotation fluoroscopies, deviations from the intended orientation of DBS leads occur during surgery but seem to be stable over long periods of time postoperatively [21,22]. These results support that once-only determination of the actual individual lead orientation being sufficient and that longitudinal reassessments might not be necessary.…”

Section: Discussionsupporting

confidence: 66%

Imaging-based programming of subthalamic nucleus deep brain stimulation in Parkinson's disease

et al. 2021

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Background:The need for imaging-guided optimization of Deep Brain Stimulation (DBS) parameters is increasing with recent developments of sophisticated lead designs offering highly individualized, but time-consuming and complex programming. Objective: The objective of this study was to compare changes in motor symptoms of Parkinson's Disease (PD) and the corresponding volume of the electrostatic field (VEsF) achieved by DBS programming using GUIDE XT™, a commercially available software for visualization of DBS leads within the patient-specific anatomy from fusions of preoperative magnetic resonance imaging (MRI) and postoperative computed tomography (CT) scans, versus standard-of-care clinical programming. Methods: Clinical evaluation was performed to identify the optimal set of parameters based on clinical effects in 29 patients with PD and bilateral directional leads for Subthalamic Nucleus (STN) DBS. A second DBS program was generated in GUIDE XT™ based on a VEsF optimally located within the dorsolateral STN. Reduction of motor symptoms (Movement Disorders Society Unified Parkinson's Disease Rating Scale, MDS-UPDRS) and the overlap of the corresponding VEsF of both programs were compared. Results: Clinical and imaging-guided programming resulted in a significant reduction in the MDS-UPDRS scores compared to off-state. Motor symptom control with GUIDE XT™-derived DBS program was noninferior to standard clinical programming. The overlap of the two VEsF did not correlate with the difference in motor symptom reduction by the programs. Conclusions: Imaging-guided programming of directional DBS leads using GUIDE XT™ is possible without computational background and leads to non-inferior motor symptom control compared with clinical programming. DBS programs based on patient-specific imaging data may thus serve as starting point for clinical testing and may promote more efficient DBS programming.

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Section: Discussionsupporting

confidence: 66%

Imaging-based programming of subthalamic nucleus deep brain stimulation in Parkinson's disease

et al. 2021

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“…60 minutes after implantation of the rst lead) was not signi cant if compared to TP1 indicating that unintended lead rotation is a very early event. This assumption is in line with the observation of other studies, which reported stable positioning for time latencies of 4-9 days or a median time latency of 82 (range 1-811) days [2,3,11].…”

Section: Discussion/ Conclusionsupporting

confidence: 92%

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

Schmidt

Buentjen

Kaufmann

et al. 2022

Preprint

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Objective: Directional deep brain stimulation (dDBS) provides multiple programming options. Knowledge of the spatial lead orientation is useful for time efficient programming. Recent studies demonstrated deviations of up to 90° from the intended orientation angle. We examined the deviation of dDBS-lead orientation for leads from two different manufacturers using intraoperative stereotactic (STX) x-ray images.Methods: Intraoperative 2D-x-ray images were acquired after implantation of the first lead (TP1) and the second lead (TP2) enabling the estimation of the spatial position of the first lead at TP1 and TP2 and of changes of the orientation for a defined time period. Two investigators retrospectively estimated the orientation of the directional marker for 64 patients.Results: The mean deviation from intended spatial orientation was 40,8° ± 46.1° for all examined leads. The spatial orientation of the first lead did not significantly change within a period of approximately one hour. The degree of deviation did not differ significantly between two lead manufacturers but depended on the lead fixation technique.Conclusion: Our results showed deviations from the intended orientation angle immediately after the insertion of dDBS leads. The initial spatial orientation remained stable for approximately one hour and was not caused by technical properties of the implanted lead. Hence it was most probably the result of unintended mechanical torsion during insertion and/or fixation. Because precise determination of the lead orientation is mandatory for target-oriented dDBS programming the use of additional imaging suitable for precise 3D-visualization of lead contacts and/or the positioning marker is recommended.

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“…Dembek and colleagues have shown that there is no rotation over time after their first postoperative CT scan~24-72 h after implantation [13]. We carried out this investigation to evaluate the immediate time course (< 25 h) of the rotational deviation at the contact level of dDBS electrodes implanted with torsion.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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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.

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Temporal Stability of Lead Orientation in Directional Deep Brain Stimulation

Cited by 16 publications

References 22 publications

Imaging-based programming of subthalamic nucleus deep brain stimulation in Parkinson's disease

Imaging-based programming of subthalamic nucleus deep brain stimulation in Parkinson's disease

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

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

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