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Gough M, Mills R, Brechany U, Nicholson C, Jenkins A, Hussain MA. Locating the ventral intermediate thalamic nucleus for deep brain stimulation surgery: analysis of a case series comparing CT and MR targeting. Br J Neurosurg 2024:1-6. [PMID: 38372013 DOI: 10.1080/02688697.2024.2313674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 01/27/2024] [Indexed: 02/20/2024]
Abstract
BACKGROUND Deep brain stimulation (DBS) surgery targeting the ventral intermediate thalamic nucleus (Vim) has proven efficacy in the treatment of tremor. AIMS The primary aim is to investigate whether there is a statistically significant difference in patient outcomes when CT-guided targeting of the Vim is compared with MRI-guided targeting. METHODS This is a retrospective study concerning patients undergoing Vim-targeted DBS at the Department of Neurosurgery, Royal Victoria Infirmary in Newcastle (9th August 2012 to 4th January 2019). Fahn-Tolosa-Marin Tremor Scale (FTM TS) and EQ-5D scores were collected from patient notes. Statistical analysis was performed using IBM® SPSS® Statistics Version 24. Independent samples t-tests were used to compare means. RESULTS Independent samples t-test did not reveal a statistically significant difference between CT (n = 10; FTM TS mean = 65.40, SD = 11.40; EQ-5D mean = 39.50, SD = 17.87) and MR (n = 7; FTM TS mean = 60.57, SD = 7.50; EQ-5D mean = 32.14, SD = 9.94) groups in pre-surgery FTM TS (t(15) = 0.977, p = 0.344) and EQ-5D (t(15) = 0.982, p = 0.342) scores. No statistically significant difference between the CT (FTM TS mean = 24.12, SD = 20.47; EQ-5D mean = 75.56, SD = 15.63) and MR (FTM TS mean = 22.86, SD = 6.72; EQ-5D mean = 70.43, SD = 15.48) groups was revealed at 1 year assessment of FTM TS (t(14) = 0.155, p = 0.879) and EQ-5D (t(14) = 0.654, p = 0.524). The median difference between pre- and post-surgery FTM TS and EQ-5D scores in the CT group at 1 year was 43.00 and 35.00, respectively. The MR patient group median difference in pre- and post-surgery at 1 year was 35.00 and 35.00 respectively. CONCLUSION No statistically significant difference between CT and MR image-guided targeting patient groups was detected.
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Affiliation(s)
| | - Russell Mills
- Department of Neurosurgery, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, United Kingdom
| | - Una Brechany
- Department of Neurosurgery, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, United Kingdom
| | - Claire Nicholson
- Department of Neurosurgery, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, United Kingdom
| | - Alistair Jenkins
- Department of Neurosurgery, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, United Kingdom
| | - Mohammed Akbar Hussain
- Department of Neurosurgery, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, United Kingdom
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Miller KJ. A Stencil Instrument for Countersinking Deep Brain Stimulator Lead Anchoring Devices. World Neurosurg 2022; 167:98-101. [PMID: 36041724 DOI: 10.1016/j.wneu.2022.08.058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 08/09/2022] [Accepted: 08/10/2022] [Indexed: 11/20/2022]
Abstract
Countersinking of deep brain stimulator lead anchoring devices reduces the risk of erosion through the scalp and improves cosmesis. This article describes a simple handheld stencil surgical instrument to assist in the countersinking process. It has 2 sides, each of which can be directly drilled through into the skull: one for making a full-thickness circular burr hole and the other for drilling a partial-thickness craniotomy to countersink the base ring of the anchoring device. This easy-to-use instrument speeds the surgery and ensures a tight contour around the base ring.
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Affiliation(s)
- Kai J Miller
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA.
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Isaacs BR, Heijmans M, Kuijf ML, Kubben PL, Ackermans L, Temel Y, Keuken MC, Forstmann BU. Variability in subthalamic nucleus targeting for deep brain stimulation with 3 and 7 Tesla magnetic resonance imaging. NEUROIMAGE-CLINICAL 2021; 32:102829. [PMID: 34560531 PMCID: PMC8463907 DOI: 10.1016/j.nicl.2021.102829] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 08/12/2021] [Accepted: 09/12/2021] [Indexed: 12/13/2022]
Abstract
Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is an effective surgical treatment for Parkinson's disease (PD). Side-effects may, however, be induced when the DBS lead is placed suboptimally. Currently, lower field magnetic resonance imaging (MRI) at 1.5 or 3 Tesla (T) is used for targeting. Ultra-high-field MRI (7 T and above) can obtain superior anatomical information and might therefore be better suited for targeting. This study aims to test whether optimized 7 T imaging protocols result in less variable targeting of the STN for DBS compared to clinically utilized 3 T images. Three DBS-experienced neurosurgeons determined the optimal STN DBS target site on three repetitions of 3 T-T2, 7 T-T2*, 7 T-R2* and 7 T-QSM images for five PD patients. The distance in millimetres between the three repetitive coordinates was used as an index of targeting variability and was compared between field strength, MRI contrast and repetition with a Bayesian ANOVA. Further, the target coordinates were registered to MNI space, and anatomical coordinates were compared between field strength, MRI contrast and repetition using a Bayesian ANOVA. The results indicate that the neurosurgeons are stable in selecting the DBS target site across MRI field strength, MRI contrast and repetitions. The analysis of the coordinates in MNI space however revealed that the actual selected location of the electrode is seemingly more ventral when using the 3 T scan compared to the 7 T scans.
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Affiliation(s)
- Bethany R Isaacs
- Integrative Model-based Cognitive Neuroscience Research Unit, University of Amsterdam, Amsterdam, The Netherlands; Translational Neuroscience, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Margot Heijmans
- Translational Neuroscience, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands.
| | - Mark L Kuijf
- Translational Neuroscience, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands; Department of Neurology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Pieter L Kubben
- Translational Neuroscience, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands; Department of Neurosurgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Linda Ackermans
- Translational Neuroscience, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands; Department of Neurosurgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Yasin Temel
- Translational Neuroscience, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands; Department of Neurosurgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Max C Keuken
- Integrative Model-based Cognitive Neuroscience Research Unit, University of Amsterdam, Amsterdam, The Netherlands
| | - Birte U Forstmann
- Integrative Model-based Cognitive Neuroscience Research Unit, University of Amsterdam, Amsterdam, The Netherlands
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Mulders AEP, Temel Y, Tonge M, Schaper FLWVJ, van Kranen-Mastenbroek V, Ackermans L, Kubben P, Janssen MLF, Duits A. The association between surgical characteristics and cognitive decline following deep brain stimulation of the subthalamic nucleus in Parkinson's disease. Clin Neurol Neurosurg 2020; 200:106341. [PMID: 33160716 DOI: 10.1016/j.clineuro.2020.106341] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 10/24/2020] [Accepted: 10/26/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Despite optimal improvement in motor functioning, both short- and long-term studies have reported small but consistent changes in cognitive functioning following STN-DBS in Parkinson's disease (PD). The aim of the present study was to explore whether surgical characteristics were associated with cognitive decline one year following STN-DBS. METHODS We retrospectively analyzed 49 PD patients who underwent bilateral STN-DBS. Cognitive change scores were related to the number of microelectrode recording (MER) trajectories, the STN length as measured by MER, and cortical entry points. Regression analyses were corrected for age at surgery, disease duration, education and preoperative levodopa responsiveness. Patients were then divided into a cognitive and non-cognitive decline group for each neuropsychological test and compared regarding demographic and surgical characteristics. RESULTS One year postoperatively, significant declines were found in verbal fluency, Stroop Color-Word test and Trail Making Test B (TMT-B). Only changes in TMT-B were associated with the coronal entry point in the right hemisphere. The number of MER trajectories and STN length were not associated with cognitive change scores. When comparing the cognitive decline and non-cognitive decline groups, no significant differences were found in surgical characteristics. CONCLUSIONS The electrode passage through the right prefrontal lobe may contribute to subtle changes in executive function. However, only few patients showed clinically relevant cognitive decline. The use of multiple MER trajectories and a longer STN length were not associated with cognitive decline one year following surgery. From a cognitive point of view, DBS may be considered a relatively safe procedure.
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Affiliation(s)
- Anne E P Mulders
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands; Department of Psychiatry and Neuropsychology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Yasin Temel
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands; Department of Neurosurgery, Maastricht University Medical Centre, Maastricht, the Netherlands; Donders Institute for Brain, Cognition and Behaviour, Department of Neurosurgery, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Mehmet Tonge
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands; Department of Neurosurgery, Istanbul Medipol Universit, Istanbul, Turkey
| | - Frédéric L W V J Schaper
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands; Department of Neurosurgery, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Vivianne van Kranen-Mastenbroek
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands; Department of Clinical Neurophysiology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Linda Ackermans
- Department of Neurosurgery, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Pieter Kubben
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands; Department of Neurosurgery, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Marcus L F Janssen
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands; Department of Clinical Neurophysiology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Annelien Duits
- Department of Psychiatry and Neuropsychology, Maastricht University Medical Centre, Maastricht, the Netherlands.
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