Use of Brain MRI after Deep Brain Stimulation Hardware Implantation

Nazzaro, Jules M.; Lyons, Kelly E.; Wetzel, Louis H.; Pahwa, Rajesh

doi:10.3109/00207450903389156

Cited by 21 publications

(15 citation statements)

References 26 publications

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“…We corroborate previous problem-free use of MRI in implanted patients for structural [21], [22], [23] as well as functional [28], [30], [32] imaging. According to our phantom experiments, fMRI carries a lower risk of thermal damage than conventional T1 – or T2 –weighted imaging which is also in agreement with previous observations [26], [97].…”

Section: Discussionsupporting

confidence: 88%

“…On the other hand, an MRI is often used by many implantation teams for confirming the position of implanted electrodes, or for structural brain imaging in cases of postoperative complications. Nevertheless, its use in hundreds of implanted patients [21], [22], [23] may serve as evidence that with adherence to defined precautions [24], [25] an MRI can be considered safe even in the presence of an intracerebral electrode [26]. The same applies to fMRI which can be used for detection of local as well as distant effects of DBS on the cerebral cortex [27].…”

Section: Introductionmentioning

confidence: 99%

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The Subthalamic Microlesion Story in Parkinson's Disease: Electrode Insertion-Related Motor Improvement with Relative Cortico-Subcortical Hypoactivation in fMRI

et al. 2012

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Electrode implantation into the subthalamic nucleus for deep brain stimulation in Parkinson's disease (PD) is associated with a temporary motor improvement occurring prior to neurostimulation. We studied this phenomenon by functional magnetic resonance imaging (fMRI) when considering the Unified Parkinson's Disease Rating Scale (UPDRS-III) and collateral oedema. Twelve patients with PD (age 55.9± (SD)6.8 years, PD duration 9–15 years) underwent bilateral electrode implantation into the subthalamic nucleus. The fMRI was carried out after an overnight withdrawal of levodopa (OFF condition): (i) before and (ii) within three days after surgery in absence of neurostimulation. The motor task involved visually triggered finger tapping. The OFF/UPDRS-III score dropped from 33.8±8.7 before to 23.3±4.8 after the surgery (p<0.001), correlating with the postoperative oedema score (p<0.05). During the motor task, bilateral activation of the thalamus and basal ganglia, motor cortex and insula were preoperatively higher than after surgery (p<0.001). The results became more enhanced after compensation for the oedema and UPDRS-III scores. In addition, the rigidity and axial symptoms score correlated inversely with activation of the putamen and globus pallidus (p<0.0001). One month later, the OFF/UPDRS-III score had returned to the preoperative level (35.8±7.0, p = 0.4).In conclusion, motor improvement induced by insertion of an inactive electrode into the subthalamic nucleus caused an acute microlesion which was at least partially related to the collateral oedema and associated with extensive impact on the motor network. This was postoperatively manifested as lowered movement-related activation at the cortical and subcortical levels and differed from the known effects of neurostimulation or levodopa. The motor system finally adapted to the microlesion within one month as suggested by loss of motor improvement and good efficacy of deep brain stimulation.

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Section: Discussionsupporting

confidence: 88%

Section: Introductionmentioning

confidence: 99%

The Subthalamic Microlesion Story in Parkinson's Disease: Electrode Insertion-Related Motor Improvement with Relative Cortico-Subcortical Hypoactivation in fMRI

et al. 2012

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“…The reduction of the maximum allowed SAR value went from 0.4 W/kg to 0.1 W/kg in 2005, which is well below the U.S. Food and Drug Administration permitted whole‐body and local head SAR limits. Recent reports have provided evidence that the strict restriction on SAR is unreasonable and provides poor quality MRI images that may hinder clinical outcomes …”

Section: Specific Absorption Ratementioning

confidence: 99%

“…Imaging with an MRI or CT scan can assess various surgical complications such as hemorrhage, edema, infarction, and brain shift . However, there is still an ongoing debate about which imaging modality provides the most precise information about electrode position . Proper electrode placement is important for effective therapeutic effect; if an electrode lead is misplaced it may be the cause of poor therapeutic results.…”

Section: Imaging Modalities For Dbs Localizationmentioning

confidence: 99%

The current state of postoperative imaging in the presence of deep brain stimulation electrodes

et al. 2017

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For more than a decade, medically refractory movement disorders have been treated with deep brain stimulation (DBS) devices. Bilateral DBS of the subthalamic nucleus (STN), globus pallidus, and thalamus have been effective in reducing the complications of medications in later-stage movement disorder patients. However, the effectiveness of the DBS device is highly dependent on the proper radiologic and electrophysiological identification of DBS target structures and the accurate placement of the DBS electrodes. The reasons for suboptimal results from DBS surgery could be related to several factors such as patient selection (preoperative), precision of DBS electrode placement (intraoperative), and inadequate device programming and follow-up (postoperative). 1 It should be mentioned from the outset that, regardless of the target, the issues of postoperative MRI in the presence of electrodes hold true.Limited clinical improvement from DBS therapy may result from misplaced electrodes during the intraoperative procedure. Magnetic resonance imaging (MRI) of DBS electrodes is the preferred method for confirming the anatomical location of electrodes given the amount of detail obtained. Recently, computerized topography (CT) has been used for electrode localization by fusing the postoperative CT with the preoperative MRI. This method could introduce more error given the fusion process required (eg, brain shift, CT air pockets). There is an implicit need for the localization of DBS electrodes with a postoperative MRI, and no amount of experienced DBS programming can compensate for a poorly placed electrode. 1 Furthermore, a CT scan cannot replace invaluable MRI scan sequences that are used for diagnostic purposes (outside electrode localization).However, the current restrictions on the postoperative MRI of electrodes has resulted in many centers opting out of the procedure. Importantly, although the potential danger imposed by MRI scanning in the presence of electrodes should not be disregarded, the fear of such procedures should not impact patient care. The current viewpoint will assume that MRI scanning is being performed with both the leads and implantable pulse generator in place. Regardless of the patient, treating neurologist, or the implantation technique, postoperative MRI scanning is invaluable for proper electrode placement verification and diagnostic applications. Specific Absorption RateIn 1979, the concept of specific absorption rate (SAR) was introduced by the National Council on Radiation Protection and Measurements for measuring the rate of radiofrequency (RF) energy absorbed by the body. SAR is defined as the mass normalized rate at which RF power is coupled to biological tissue. 2 SAR is measured in units of watts per kilogram (W/kg). 2 The objective of calculating SAR is to limit the rise in body temperature as a result of RF deposition during the MRI procedure. During the MRI procedure, the patient's body temperature is not easy to detect, so SAR is used to control the potential temperature increases. 2 ...

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“…All surgical tools needed to be MRI compatible, including an MRI-compatible drill. The risk of severe injury with the lead inserted into the brain when a 1.5-T MRI scan is performed has been already reported but has to be counterbalanced with the large number of patients in whom MRI scans, using head coils, have been performed also without any problems [4,6,16,25]. While some isolated MR complications occurred in implanted patients, with the need to modify safety rules [7,9,21], many teams reported accuracy, innocuousness, and advantages of its use.…”

Section: Feasibility and Technical Requirementmentioning

confidence: 99%

Surgical implantation of STN-DBS leads using intraoperative MRI guidance: technique, accuracy, and clinical benefit at 1-year follow-up

et al. 2015

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Background Improvement of surgical accuracy during DBSlead implantation has been described recently, leading to Bframeless^or BMRI-verifiedB techniques. However, combining a high-quality definition of the STN using intraoperative 1.5 MRI with the possibility to reduce errors due to coregistration and to monitor lead progression during surgical insertion while checking the absence of surgical complication is an appealing method. We report here surgical methodology, safety, application accuracy, and clinical benefit of STN-lead implantation under MRI guidance. Methods Two patients with a severe PD state were treated by bilateral STN-DBS. Leads were implanted under general anesthesia using intraoperative MRI guidance (ClearPoint system). Lead implantation accuracy was measured on T1 axial images at the level of the target. Clinical improvement was measured on the pre-and post-UPDRS 3 scale at 1-year follow-up. Results Surgery was safe and uneventful in both cases. Radial error was 0.36 (right) and 0.86 mm (left) in case 1, and 0.41 (right) and 0.14 mm (left) in case 2. No edema or hemorrhage were noticed. Conclusions Intraoperative MRI guidance allows DBS lead implantation with high accuracy and with great clinical efficacy. A larger cohort of patients is needed to confirm these initial results.

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Use of Brain MRI after Deep Brain Stimulation Hardware Implantation

Cited by 21 publications

References 26 publications

The Subthalamic Microlesion Story in Parkinson's Disease: Electrode Insertion-Related Motor Improvement with Relative Cortico-Subcortical Hypoactivation in fMRI

The Subthalamic Microlesion Story in Parkinson's Disease: Electrode Insertion-Related Motor Improvement with Relative Cortico-Subcortical Hypoactivation in fMRI

The current state of postoperative imaging in the presence of deep brain stimulation electrodes

Surgical implantation of STN-DBS leads using intraoperative MRI guidance: technique, accuracy, and clinical benefit at 1-year follow-up

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