The first evaluation of brain shift during functional neurosurgery by deformation field analysis

Abstract

Stereotactic surgery is based on a high degree of accuracy in defining and localising intracranial targets and placing surgical tools. Brain shift can influence its accuracy significantly. Deep brain stimulation of the subthalamic nucleus can markedly change the quality of life of patients with advanced Parkinson's disease, but the outcome depends on the quality of electrode placement. A patient is reported in whom the placement of the second electrode was not successful. Deformation field analysis of pre- and postoperative three dimensional magnetic resonance images showed an intraoperative brain movement of 2 mm in the region of the subthalamic nucleus (the target point). Electrode repositioning resulted in efficient stimulation effects. This case report shows the need to reduce risk factors for intraoperative brain movement and demonstrates the ability of deformation field analysis to quantify this complication

Bilateral Deep Brain Stimulation: The Placement of the Second Electrode Is Not Necessarily Less Accurate Than That of the First One

“…Our results can be explained by intra-operative brain shift, already reported and described by many authors [1,2,3,12,13,14]. Some authors have described that brain shift may be more important on the second side of surgery.…”

“…Some authors have described that brain shift may be more important on the second side of surgery. Winkler et al [14] described in a short report in 2005 the case of a 70-year-old patient who underwent bilateral STN DBS for Parkinson's disease and in whom the position of the second implanted electrode was displaced by 2 mm off the target, probably because of brain shift. The patient underwent a further operation the next day in order to replace this displaced electrode.…”

Subthalamic electrode implantation using the MicroDrive system and the importance of microrecording data

“…A frontal cortex shift of -12 mm was associated with a 2 mm subthalamic nucleus shift. Morphological results were supported by microelectrode data (24).…”

Implementing Conventional Zamorano Dujovny Frames versus Individually Manufactured microTargeting™ Platforms - A Comparative Study on Deep Brain Stimulation in Parkinson Patients

“…In bilateral surgery and conventional stereotactic surgery, the equipment has to be removed and reinstalled, readjusted and verified on the contralateral side, which is also time-consuming. Several studies have proven the time-dependent decrease of image accuracy caused by intraoperative brain shift as a result of cerebrospinal fluid loss, gravity, anesthesia and factors that increase liquor flow (brain immanent characteristics), confirmed by our own experience [22]. This expressly underlines the requirement of a stringent surgery to prevent brain-shift-associated inaccuracies.…”