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Neto-Fernandes P, Chamadoira C, Silva C, Pereira L, Vaz R, Rito M, Ferreira-Pinto MJ. Intraoperative 3D fluoroscopy accurately predicts final electrode position in deep brain stimulation surgery. Acta Neurochir (Wien) 2024; 166:328. [PMID: 39107666 PMCID: PMC11303432 DOI: 10.1007/s00701-024-06214-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Accepted: 07/27/2024] [Indexed: 08/10/2024]
Abstract
PURPOSE In the absence of an intraoperative CT or MRI setup, post-implantation confirmation of electrode position in deep brain stimulation (DBS) requires patient transportation to the radiology unit, prolonging surgery time. This project aims to validate intraoperative 3D fluoroscopy (3DF), a widely available tool in Neurosurgical units, as a method to determine final electrode position. METHODS We performed a retrospective study including 64 patients (124 electrodes) who underwent DBS at our institution. Intraoperative 3DF after electrode implantation and postoperative volumetric CT were acquired. The Euclidean coordinates of the electrode tip displayed in both imaging modalities were determined and inter-method deviations were assessed. Pneumocephalus was quantified and its potential impact in determining the electrode position analyzed. Finally, 3DF and CT-imposed exposure to radiation was compared. RESULTS The difference between the electrode tip estimated by 3DF and CT was 0.85 ± 0.03 mm, and not significantly different (p = 0.11 for the distance to MCP assessed by both methods), but was, instead, highly correlated (p = 0.91; p < 0.0001). Even though pneumocephalus was larger in 3DF (6.89 ± 1.76 vs 5.18 ± 1.37 mm3 in the CT group, p < 0.001), it was not correlated with the difference in electrode position measured by both techniques (p = 0.17; p = 0.06). Radiation exposure from 3DF is significantly lower than CT (0.36 ± 0.03 vs 2.08 ± 0.05 mSv; p < 0.0001). CONCLUSIONS Intraoperative 3DF is comparable to CT in determining the final DBS electrode position. Being a method with fewer radiation exposure, less expensive, faster and that avoids patient transportation outside the operation room, it is a valid tool to replace postoperative CT.
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Affiliation(s)
- Patrícia Neto-Fernandes
- Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal
- Department of Neurosurgery, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Clara Chamadoira
- Department of Neurosurgery, Centro Hospitalar Universitário de São João, Porto, Portugal
- Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Carolina Silva
- Department of Neurosurgery, Centro Hospitalar Universitário de São João, Porto, Portugal
- Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Leila Pereira
- Department of Radiology, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Rui Vaz
- Department of Neurosurgery, Centro Hospitalar Universitário de São João, Porto, Portugal
- Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Manuel Rito
- Department of Neurosurgery, Centro Hospitalar Universitário de São João, Porto, Portugal
- Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Manuel J Ferreira-Pinto
- Department of Neurosurgery, Centro Hospitalar Universitário de São João, Porto, Portugal.
- Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto, Porto, Portugal.
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal.
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Al-Jaberi F, Moeskes M, Skalej M, Fachet M, Hoeschen C. 3D-visualization of segmented contacts of directional deep brain stimulation electrodes via registration and fusion of CT and FDCT. EJNMMI REPORTS 2024; 8:17. [PMID: 38872028 PMCID: PMC11286893 DOI: 10.1186/s41824-024-00208-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 05/02/2024] [Indexed: 06/15/2024]
Abstract
OBJECTIVES 3D-visualization of the segmented contacts of directional deep brain stimulation (DBS) electrodes is desirable since knowledge about the position of every segmented contact could shorten the timespan for electrode programming. CT cannot yield images fitting that purpose whereas highly resolved flat detector computed tomography (FDCT) can accurately image the inner structure of the electrode. This study aims to demonstrate the applicability of image fusion of highly resolved FDCT and CT to produce highly resolved images that preserve anatomical context for subsequent fusion to preoperative MRI for eventually displaying segmented contactswithin anatomical context in future studies. MATERIAL AND METHODS Retrospectively collected datasets from 15 patients who underwent bilateral directional DBS electrode implantation were used. Subsequently, after image analysis, a semi-automated 3D-registration of CT and highly resolved FDCT followed by image fusion was performed. The registration accuracy was assessed by computing the target registration error. RESULTS Our work demonstrated the feasibility of highly resolved FDCT to visualize segmented electrode contacts in 3D. Semiautomatic image registration to CT was successfully implemented in all cases. Qualitative evaluation by two experts revealed good alignment regarding intracranial osseous structures. Additionally, the average for the mean of the target registration error over all patients, based on the assessments of two raters, was computed to be 4.16 mm. CONCLUSION Our work demonstrated the applicability of image fusion of highly resolved FDCT to CT for a potential workflow regarding subsequent fusion to MRI in the future to put the electrodes in an anatomical context.
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Affiliation(s)
- Fadil Al-Jaberi
- Chair of Medical Systems Technology, Institute for Medical Technology, Faculty of Electrical Engineering and Information Technology, Otto von Guericke University Magdeburg, Universitätsplatz 2, 39106, Magdeburg, Germany.
- Research Department, Missan Oil Company, Iraqi Ministry of Oil, Baghdad, Iraq.
| | - Matthias Moeskes
- Institute of Biometry and Medical Informatics, Medical Faculty, Otto von Guericke University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Martin Skalej
- Neuroradiology, Medical Faculty, Martin Luther University Halle-Wittenberg, Ernst-Grube-Straße 40, 06120, Halle, Germany
| | - Melanie Fachet
- Chair of Medical Systems Technology, Institute for Medical Technology, Faculty of Electrical Engineering and Information Technology, Otto von Guericke University Magdeburg, Universitätsplatz 2, 39106, Magdeburg, Germany
| | - Christoph Hoeschen
- Chair of Medical Systems Technology, Institute for Medical Technology, Faculty of Electrical Engineering and Information Technology, Otto von Guericke University Magdeburg, Universitätsplatz 2, 39106, Magdeburg, Germany
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Krauss P, Duarte-Batista P, Hart M, Avecillas-Chasin J, Bercu M, Hvingelby V, Massey F, Ackermans L, Kubben P, van der Gaag N, Krüger M. Directional electrodes in deep brain stimulation: Results of a survey by the European Association of Neurosurgical Societies (EANS). BRAIN & SPINE 2024; 4:102756. [PMID: 38510592 PMCID: PMC10951785 DOI: 10.1016/j.bas.2024.102756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 01/05/2024] [Accepted: 01/21/2024] [Indexed: 03/22/2024]
Abstract
Introduction Directional Leads (dLeads) represent a new technical tool in Deep Brain Stimulation (DBS), and a rapidly growing population of patients receive dLeads. Research question The European Association of Neurosurgical Societies(EANS) functional neurosurgery Task Force on dLeads conducted a survey of DBS specialists in Europe to evaluate their use, applications, advantages, and disadvantages. Material and methods EANS functional neurosurgery and European Society for Stereotactic and Functional Neurosurgery (ESSFN) members were asked to complete an online survey with 50 multiple-choice and open questions on their use of dLeads in clinical practice. Results Forty-nine respondents from 16 countries participated in the survey (n = 38 neurosurgeons, n = 8 neurologists, n = 3 DBS nurses). Five had not used dLeads. All users reported that dLeads provided an advantage (n = 23 minor, n = 21 major). Most surgeons (n = 35) stated that trajectory planning does not differ when implanting dLeads or conventional leads. Most respondents selected dLeads for the ability to optimize stimulation parameters (n = 41). However, the majority (n = 24), regarded time-consuming programming as the main disadvantage of this technology. Innovations that were highly valued by most participants included full 3T MRI compatibility, remote programming, and closed loop technology. Discussion and conclusion Directional leads are widely used by European DBS specialists. Despite challenges with programming time, users report that dLeads have had a positive impact and maintain an optimistic view of future technological advances.
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Affiliation(s)
- P. Krauss
- Department of Neurosurgery, University Hospital Augsburg, Augsburg, Germany
| | - P. Duarte-Batista
- Neurosurgery Department, North Lisbon University Hospital Centre, Lisbon, Portugal
| | - M.G. Hart
- St George's, University of London & St George's University Hospitals NHS Foundation Trust, Institute of Molecular and Clinical Sciences, Neurosciences Research Centre, Cranmer Terrace, London, United Kingdom
| | - J.M. Avecillas-Chasin
- Department of Neurosurgery. University of Nebraska Medical Center. Omaha, Nebraska, USA
| | - M.M. Bercu
- Department of Pediatric Neurosurgery, Helen DeVos Children's Hospital, Corewell, USA
| | - V. Hvingelby
- Department of Clinical Medicine - Nuclear Medicine and PET Center, Aarhus University, Aarhus, Denmark
| | - F. Massey
- Unit of Neurosurgery, National Hospital of Neurology and Neurosurgery, London, United Kingdom
| | - L. Ackermans
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - P.L. Kubben
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - N.A. van der Gaag
- Department of Neurosurgery, Haga Teaching Hospital, The Hague, the Netherlands
- Department of Neurosurgery, Leiden University Medical Center, Leiden, the Netherlands
| | - M.T. Krüger
- Unit of Neurosurgery, National Hospital of Neurology and Neurosurgery, London, United Kingdom
- Department of Neurosurgery, University Medical Centre Freiburg, Germany
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Manfield J, Thomas S, Antoniades C, Green AL, FitzGerald JJ. High resolution photon counting CT permits direct visualisation of directional deep brain stimulation lead segments and markers. Brain Stimul 2023; 16:1276-1277. [PMID: 37611658 DOI: 10.1016/j.brs.2023.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 06/29/2023] [Accepted: 08/18/2023] [Indexed: 08/25/2023] Open
Affiliation(s)
- James Manfield
- Oxford Functional Neurosurgery, John Radcliffe Hospital, Oxford, UK
| | - Sheena Thomas
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Charalambos Antoniades
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Alexander L Green
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK; Oxford Functional Neurosurgery, John Radcliffe Hospital, Oxford, UK
| | - James J FitzGerald
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK; Oxford Functional Neurosurgery, John Radcliffe Hospital, Oxford, UK.
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Henry KR, Miulli MM, Elahi B, Rosenow J, Nolt M, Golestanirad L. Analysis of the intended and actual orientations of directional deep brain stimulation leads across deep brain stimulation systems. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2022; 2022:1725-1728. [PMID: 36086443 PMCID: PMC10848154 DOI: 10.1109/embc48229.2022.9871608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Deep brain stimulation (DBS) offers therapeutic benefits to patients suffering from a variety of treatment-resistant neurological and psychiatric disorders. The newest generation of DBS devices now offer directional leads, which utilize segmented electrodes to direct current asymmetrically to the neuronal tissue. Since segmented electrodes offer a larger degree of freedom for contact positioning, it is critical to assess how well the surgically intended and the actual orientation of the lead match to facilitate programming and allow appropriate interpretation of the therapeutic outcome. Postoperative image analysis algorithms, such as DiODe, are commonly used to determine DBS leads' actual orientation. In this work, we used DiODe to compare the deviation between intended and actual orientations of DBS leads across two most commonly implanted directional DBS systems, namely, Boston Scientific Cartesia™ and St. Jude Medical Infinity. This study is the first to investigate the rotation of leads from both DBS systems in a large group of 86 patients. Clinical Relevance- Our results quantify the variability between the surgically intended and actual orientations of Boston Scientific Vercise and St. Jude Medical Infinity DBS systems thus highlighting the need to develop more precise implantation procedures.
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Mishra A, Ramdhani RA. Directional Deep Brain Stimulation in the Treatment of Parkinson's Disease. Neurology 2022. [DOI: 10.17925/usn.2022.18.1.64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Deep brain stimulation (DBS) is a treatment modality that has been shown to improve the clinical outcomes of individuals with movement disorders, including Parkinson's disease. Directional DBS represents an advance in the field that allows clinicians to better modulate the electrical stimulation to increase therapeutic gains while minimizing side effects. In this review, we summarize the principles of directional DBS, including available technologies and stimulation paradigms, and examine the growing clinical study data with respect to its use in Parkinson's disease.
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Masuda H, Shirozu H, Ito Y, Fukuda M, Fujii Y. Surgical Strategy for Directional Deep Brain Stimulation. Neurol Med Chir (Tokyo) 2021; 62:1-12. [PMID: 34719582 PMCID: PMC8754682 DOI: 10.2176/nmc.ra.2021-0214] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Deep brain stimulation (DBS) is a well-established treatment for drug-resistant involuntary movements. However, the conventional quadripole cylindrical lead creates electrical fields in all directions, and the resulting spread to adjacent eloquent structures may induce unintended effects. Novel directional leads have therefore been designed to allow directional stimulation (DS). Directional leads have the advantage of widening the therapeutic window (TW), compensating for slight misplacement of the lead and requiring less electrical power to provide the same effect as a cylindrical lead. Conversely, the increase in the number of contacts from four to eight and the addition of directional elements has made stimulation programming more complex. For these reasons, new treatment strategies are required to allow effective directional DBS. During lead implantation, the directional segment should be placed in a "sweet spot," and the orientation of the directional segment is important for programming. Trial-and-error testing of a large number of contacts is unnecessary, and efficient and systematic execution of the programmed procedure is desirable. Recent improvements in imaging technologies have enabled image-guided programming. In the future, optimal stimulations are expected to be programmed by directional recording of local field potentials.
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Affiliation(s)
- Hiroshi Masuda
- Division of Functional Neurosurgery, Nishiniigata National Hospital
| | - Hiroshi Shirozu
- Division of Functional Neurosurgery, Nishiniigata National Hospital
| | - Yosuke Ito
- Division of Functional Neurosurgery, Nishiniigata National Hospital
| | - Masafumi Fukuda
- Division of Functional Neurosurgery, Nishiniigata National Hospital
| | - Yukihiko Fujii
- Department of Neurosurgery, Brain Research Institute, Niigata University
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