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Rajabian A, Vinke S, Candelario-Mckeown J, Milabo C, Salazar M, Nizam AK, Salloum N, Hyam J, Akram H, Joyce E, Foltynie T, Limousin P, Hariz M, Zrinzo L. Accuracy, precision, and safety of stereotactic, frame-based, intraoperative MRI-guided and MRI-verified deep brain stimulation in 650 consecutive procedures. J Neurosurg 2023; 138:1702-1711. [PMID: 36308483 DOI: 10.3171/2022.8.jns22968] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 08/30/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Suboptimal lead placement is one of the most common indications for deep brain stimulation (DBS) revision procedures. Confirming lead placement in relation to the visible anatomical target with dedicated stereotactic imaging before terminating the procedure can mitigate this risk. In this study, the authors examined the accuracy, precision, and safety of intraoperative MRI (iMRI) to both guide and verify lead placement during frame-based stereotactic surgery. METHODS A retrospective analysis of 650 consecutive DBS procedures for targeting accuracy, precision, and perioperative complications was performed. Frame-based lead placement took place in an operating room equipped with an MRI machine using stereotactic images to verify lead placement before removing the stereotactic frame. Immediate lead relocation was performed when necessary. Systematic analysis of the targeting error was calculated. RESULTS Verification of 1201 DBS leads with stereotactic MRI was performed in 643 procedures and with stereotactic CT in 7. The mean ± SD of the final targeting error was 0.9 ± 0.3 mm (range 0.1-2.3 mm). Anatomically acceptable lead placement was achieved with a single brain pass for 97% (n = 1164) of leads; immediate intraoperative relocation was performed in 37 leads (3%) to obtain satisfactory anatomical placement. General anesthesia was used in 91% (n = 593) of the procedures. Hemorrhage was noted after 4 procedures (0.6%); 3 patients (0.4% of procedures) presented with transient neurological symptoms, and 1 experienced delayed cognitive decline. Two bleeds coincided with immediate relocation (2 of 37 leads, 5.4%), which contrasts with hemorrhage in 2 (0.2%) of 1164 leads implanted on the first pass (p = 0.0058). Three patients had transient seizures in the postoperative period. The seizures coincided with hemorrhage in 2 of these patients and with immediate lead relocation in the other. There were 21 infections (3.2% of procedures, 1.5% in 3 months) leading to hardware removal. Delayed (> 3 months) retargeting of 6 leads (0.5%) in 4 patients (0.6% of procedures) was performed because of suboptimal stimulation benefit. There were no MRI-related complications, no permanent motor deficits, and no deaths. CONCLUSIONS To the authors' knowledge, this is the largest series reporting the use of iMRI to guide and verify lead location during DBS surgery. It demonstrates a high level of accuracy, precision, and safety. Significantly higher hemorrhage was encountered when multiple brain passes were required for lead implantation, although none led to permanent deficit. Meticulous audit and calibration can improve precision and maximize safety.
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Affiliation(s)
- Ali Rajabian
- 1Department of Clinical and Movement Neurosciences, Functional Neurosurgery Unit, University College London, Institute of Neurology, Queen Square, London, United Kingdom
- 2Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom; and
| | - Saman Vinke
- 1Department of Clinical and Movement Neurosciences, Functional Neurosurgery Unit, University College London, Institute of Neurology, Queen Square, London, United Kingdom
| | - Joseph Candelario-Mckeown
- 1Department of Clinical and Movement Neurosciences, Functional Neurosurgery Unit, University College London, Institute of Neurology, Queen Square, London, United Kingdom
| | - Catherine Milabo
- 1Department of Clinical and Movement Neurosciences, Functional Neurosurgery Unit, University College London, Institute of Neurology, Queen Square, London, United Kingdom
| | - Maricel Salazar
- 1Department of Clinical and Movement Neurosciences, Functional Neurosurgery Unit, University College London, Institute of Neurology, Queen Square, London, United Kingdom
| | - Abdul Karim Nizam
- 1Department of Clinical and Movement Neurosciences, Functional Neurosurgery Unit, University College London, Institute of Neurology, Queen Square, London, United Kingdom
| | - Nadia Salloum
- 1Department of Clinical and Movement Neurosciences, Functional Neurosurgery Unit, University College London, Institute of Neurology, Queen Square, London, United Kingdom
| | - Jonathan Hyam
- 1Department of Clinical and Movement Neurosciences, Functional Neurosurgery Unit, University College London, Institute of Neurology, Queen Square, London, United Kingdom
- 2Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom; and
| | - Harith Akram
- 1Department of Clinical and Movement Neurosciences, Functional Neurosurgery Unit, University College London, Institute of Neurology, Queen Square, London, United Kingdom
- 2Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom; and
| | - Eileen Joyce
- 1Department of Clinical and Movement Neurosciences, Functional Neurosurgery Unit, University College London, Institute of Neurology, Queen Square, London, United Kingdom
| | - Thomas Foltynie
- 1Department of Clinical and Movement Neurosciences, Functional Neurosurgery Unit, University College London, Institute of Neurology, Queen Square, London, United Kingdom
| | - Patricia Limousin
- 1Department of Clinical and Movement Neurosciences, Functional Neurosurgery Unit, University College London, Institute of Neurology, Queen Square, London, United Kingdom
| | - Marwan Hariz
- 1Department of Clinical and Movement Neurosciences, Functional Neurosurgery Unit, University College London, Institute of Neurology, Queen Square, London, United Kingdom
- 3Department of Clinical Neuroscience, Umeå University, Umeå, Sweden
| | - Ludvic Zrinzo
- 1Department of Clinical and Movement Neurosciences, Functional Neurosurgery Unit, University College London, Institute of Neurology, Queen Square, London, United Kingdom
- 2Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom; and
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