The Effect of Surgical Positioning on Pneumocephalus in Subthalamic Nucleus Deep Brain Stimulation Surgery for Parkinson Disease

Wu, Bin; Xu, Jiakun; Zhang, Changming; Yang, Luwei; Yang, Chao; Xuan, Ruoheng; Wang, Simin; Guo, Qianqian; Zeng, Zixia; Jiang, Nan; Chen, Ling; Liu, Jinlong

doi:10.1016/j.neurom.2022.09.003

Cited by 5 publications

(2 citation statements)

References 12 publications

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“…Further risk factors for CSF loss include: patient positioning, operative time, cerebral atrophy, and Valsalva maneuvers [4]. There are five factors which have been shown to contribute to intra-operative pneumocephalus: 1-pre-existent brain atrophy [1], 2-loss of the CSF negative-pressure gradient, 3-air inflow, 4-loss of CSF [3], and 5-use of the semi-sitting surgical position [5]. Strategies which can be employed to prevent air embolism during surgery include positioning in the recumbent position when opening the dura, generous irrigation with saline during any suspected air embolization [6,7], and the addition of wax to the burr hole following dural opening; as a method to seal a potentially injured venous sinus [8,9].…”

Section: Preventing Brain Shiftmentioning

confidence: 99%

Preventing Shift from Pneumocephalus During Deep Brain Stimulation Surgery: Don’t Give Up the ‘Fork in the Brain’

Martinez-Nunez,

Wong,

Hilliard

et al. 2024

Tremor and Other Hyperkinetic Movements

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Clinical vignette:We present the case of a patient who developed intra-operative pneumocephalus during left globus pallidus internus deep brain stimulation (DBS) placement for Parkinson's disease (PD). Microelectrode recording (MER) revealed that we were anterior and lateral to the intended target.Clinical dilemma: Clinically, we suspected brain shift from pneumocephalus. Removal of the guide-tube for readjustment of the brain target would have resulted in the introduction of movement resulting from brain shift and from displacement from the planned trajectory. Clinical solution:We elected to leave the guide-tube cannula in place and to pass the final DBS lead into a channel that was located posterior-medially from the center microelectrode pass. Gap in knowledge:Surgical techniques which can be employed to minimize brain shift in the operating room setting are critical for reduction in variation of the final DBS lead placement. Pneumocephalus after dural opening is one potential cause of brain shift. The recognition that the removal of a guide-tube cannula could worsen brain shift creates an opportunity for an intraoperative team to maintain the advantage of the 'fork' in the brain provided by the initial procedure's requirement of guide-tube placement.

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Section: Preventing Brain Shiftmentioning

confidence: 99%

Preventing Shift from Pneumocephalus During Deep Brain Stimulation Surgery: Don’t Give Up the ‘Fork in the Brain’

Martinez-Nunez,

Wong,

Hilliard

et al. 2024

Tremor and Other Hyperkinetic Movements

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“…Therefore, the careful and correct localization of the STN during this surgery is paramount. As a result, the accurate placement of the electrode within the dorsolateral sensorimotor part of the STN is considered necessary for a satisfactory outcome [10,11].…”

Section: Introductionmentioning

confidence: 99%

Using Ensemble of Hand-Feature Engineering and Machine Learning Classifiers for Refining the Subthalamic Nucleus Location from Micro-Electrode Recordings in Parkinson’s Disease

Benouis,

Rosado-Muñoz

2024

Applied Sciences

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When pharmaceutical treatments for Parkinson’s Disease (PD) are no longer effective, Deep Brain Stimulation (DBS) surgery, a procedure that entails the stimulation of the Subthalamic Nucleus (STN), is another treatment option. However, the success rate of this surgery heavily relies on the precise location of the STN, as well as the correct positioning of the stimulation electrode. In order to ensure the correct location, Micro-Electrode Recordings (MERs) are analyzed. During surgery, MERs capture brain signals while inserted in the brain, receiving different brain activity depending on the crossed brain area. The location of the STN is guaranteed when brain signals from MERs meet certain criteria. Nevertheless, MER signals are sensitive to various artifacts coming from machinery or other electrical equipment in the operating theater; patient activity; and electrode motion. These all lower the signal-to-noise ratio of the MER signals. MER signals are stochastic, multicomponent, transient, and non-stationary in nature, and they contain multi-unit neural activity in the form of spikes and artefacts. Thus, accurately defining that MERs are located in the STN is not an easy task. This work analyzes relevant features from MER, based on analyzing spike activity and local field signals. Six different classification algorithms are used, together with the optimal input feature selection. The algorithms are trained using supervised Leave-One-Out Cross-Validation. MER data were collected in a real scenario from 14 PD patients during DBS implantation surgery. The dataset is publicly available. The results derived from the use of this method show an accuracy of up to 100% in detecting where the MER electrode is located in the STN brain area.

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Intraoperative microelectrode recording during asleep deep brain stimulation of subthalamic nucleus for Parkinson Disease. A case series with systematic review of the literature

Izzo,

Piano,

D’Ercole

et al. 2024

Neurosurg Rev

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The use of microelectrode recording (MER) during deep brain stimulation (DBS) for Parkinson Disease is controversial. Furthermore, in asleep DBS anesthesia can impair the ability to record single-cell electric activity.The purpose of this study was to describe our surgical and anesthesiologic protocol for MER assessment during asleep subthalamic nucleus (STN) DBS and to put our findings in the context of a systematic review of the literature. Sixty-three STN electrodes were implanted in 32 patients under general anesthesia. A frameless technique using O-Arm scanning was adopted in all cases. Total intravenous anesthesia, monitored with bispectral index, was administered using a target controlled infusion of both propofol and remifentanil. A systematic review of the literature with metanalysis on MER in asleep vs awake STN DBS for Parkinson Disease was performed. In our series, MER could be reliably recorded in all cases, impacting profoundly on electrode positioning: the final position was located within 2 mm from the planned target only in 42.9% cases. Depth modification > 2 mm was necessary in 21 cases (33.3%), while in 15 cases (23.8%) a different track was used. At 1-year follow-up we observed a significant reduction in LEDD, UPDRS Part III score off-medications, and UPDRS Part III score on medications, as compared to baseline. The systematic review of the literature yielded 23 papers; adding the cases here reported, overall 1258 asleep DBS cases using MER are described. This technique was safe and effective: metanalysis showed similar, if not better, outcome of asleep vs awake patients operated using MER. MER are a useful and reliable tool during asleep STN DBS, leading to a fine tuning of electrode position in the majority of cases. Collaboration between neurosurgeon, neurophysiologist and neuroanesthesiologist is crucial, since slight modifications of sedation level can impact profoundly on MER reliability.

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The Effect of Surgical Positioning on Pneumocephalus in Subthalamic Nucleus Deep Brain Stimulation Surgery for Parkinson Disease

Cited by 5 publications

References 12 publications

Preventing Shift from Pneumocephalus During Deep Brain Stimulation Surgery: Don’t Give Up the ‘Fork in the Brain’

Preventing Shift from Pneumocephalus During Deep Brain Stimulation Surgery: Don’t Give Up the ‘Fork in the Brain’

Using Ensemble of Hand-Feature Engineering and Machine Learning Classifiers for Refining the Subthalamic Nucleus Location from Micro-Electrode Recordings in Parkinson’s Disease

Intraoperative microelectrode recording during asleep deep brain stimulation of subthalamic nucleus for Parkinson Disease. A case series with systematic review of the literature

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