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Bunyaratavej K, Phokaewvarangkul O, Wangsawatwong P. Placement accuracy of the second electrode in bilateral deep brain stimulation surgery. Br J Neurosurg 2024; 38:1078-1085. [PMID: 34939521 DOI: 10.1080/02688697.2021.2019677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 11/26/2021] [Accepted: 12/14/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Due to brain shift during bilateral deep brain stimulation (DBS) surgery, placement of the second electrode may be subjected to more error than that of the first electrode. The authors aimed to investigate the accuracy of second electrode placement in this setting. MATERIALS AND METHODS Fifty-five patients with Parkinson's disease who underwent bilateral DBS surgery (110 electrodes) were retrospectively evaluated. The targets were subthalamic nucleus (STN) and globus pallidus interna (GPi) in 40 and 15 cases, respectively. Preoperative planning and postoperative electrode images were co-registered to compare the error margin between the two sides. RESULTS There is a statistically significant difference in the directional axis error along the y axis only when comparing each laterality (posterior 0.04 ± 1.21 mm vs anterior 0.41 ± 1.07 mm, p = 0.006). There is no significant difference of other error parameters, final track location, and number of microelectrode recording passes between the two sides. In a subgroup analysis, there is a significant difference in directional axis error along the y axis only in the STN subgroup (posterior 0.40 ± 1.05 mm vs anterior 0.18 ± 1.04 mm, p = 0.003). CONCLUSION Although a statistically significant difference in directional axis error along the y axis was found between first and second electrode placements in the STN group but not in the GPi group, its magnitude is well below the clinically significant threshold.
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Affiliation(s)
- Krishnapundha Bunyaratavej
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Onanong Phokaewvarangkul
- Chulalongkorn Center of Excellence for Parkinson's Disease and Related Disorders, Division of Neurology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Piyanat Wangsawatwong
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
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Zulkarnain NIH, Sadeghi-Tarakameh A, Thotland J, Harel N, Eryaman Y. A workflow for predicting radiofrequency-induced heating around bilateral deep brain stimulation electrodes in MRI. Med Phys 2024; 51:1007-1018. [PMID: 38153187 PMCID: PMC10922480 DOI: 10.1002/mp.16913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 10/04/2023] [Accepted: 12/10/2023] [Indexed: 12/29/2023] Open
Abstract
BACKGROUND Heating around deep brain stimulation (DBS) in magnetic resonance imaging (MRI) occurs when the time-varying electromagnetic (EM) fields induce currents in the electrodes which can generate heat and potentially cause tissue damage. Predicting the heating around the electrode contacts is important to ensure the safety of patients with DBS implants undergoing an MRI scan. We previously proposed a workflow to predict heating around DBS contacts and introduced a parameter, equivalent transimpedance, that is independent of electrode trajectories, termination, and radiofrequency (RF) excitations. The workflow performance was validated in a unilateral DBS system. PURPOSE To predict RF heating around the contacts of bilateral (DBS) electrodes during an MRI scan in an anthropomorphic head phantom. METHODS Bilateral electrodes were fixed in a skull phantom filled with hydroxyethyl cellulose (HEC) gel. The electrode shafts were suspended extracranially, in a head and torso phantom filled with the same gel material. The current induced on the electrode shaft was experimentally measured using an MR-based technique 3 cm above the tip. A transimpedance value determined in a previous offline calibration was used to scale the shaft current and calculate the contact voltage. The voltage was assigned as a boundary condition on the electrical contacts of the electrode in a quasi-static (EM) simulation. The resulting specific absorption rate (SAR) distribution became the input for a transient thermal simulation and was used to predict the heating around the contacts. RF heating experiments were performed for eight different lead trajectories using circularly polarized (CP) excitation and two linear excitations for one trajectory. The measured temperatures for all experiments were compared with the simulated temperatures and the root-mean-squared errors (RMSE) were calculated. RESULTS The RF heating around the contacts of both bilateral electrodes was predicted with ≤ 0.29°C of RMSE for 20 heating scenarios. CONCLUSION The workflow successfully predicted the heating for different bilateral DBS trajectories and excitation patterns in an anthropomorphic head phantom.
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Affiliation(s)
- Nur Izzati Huda Zulkarnain
- Center for Magnetic Resonance Research (CMRR), University of Minnesota, Minneapolis, Minnesota, 55455, USA
| | - Alireza Sadeghi-Tarakameh
- Center for Magnetic Resonance Research (CMRR), University of Minnesota, Minneapolis, Minnesota, 55455, USA
| | - Jeromy Thotland
- Center for Magnetic Resonance Research (CMRR), University of Minnesota, Minneapolis, Minnesota, 55455, USA
| | - Noam Harel
- Center for Magnetic Resonance Research (CMRR), University of Minnesota, Minneapolis, Minnesota, 55455, USA
| | - Yigitcan Eryaman
- Center for Magnetic Resonance Research (CMRR), University of Minnesota, Minneapolis, Minnesota, 55455, USA
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Yearley AG, Chua M, Horn A, Cosgrove GR, Rolston JD. Deep Brain Stimulation Lead Localization Variability Comparing Intraoperative MRI Versus Postoperative Computed Tomography. Oper Neurosurg (Hagerstown) 2023; 25:441-448. [PMID: 37584483 DOI: 10.1227/ons.0000000000000849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 06/02/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Commercially available lead localization software for deep brain stimulation (DBS) often relies on postoperative computed tomography (CT) scans to define electrode positions. When cases are performed with intraoperative MRI, another imaging set exists with which to perform these localizations. To compare DBS localization error between postoperative CT scans and intraoperative MRI. METHODS A retrospective cohort of patients who underwent MRI-guided placement of DBS electrodes using the ClearPoint platform was identified. Using Brainlab Elements, postoperative CT scans were coregistered to intraoperative magnetic resonance images visualizing the ClearPoint guidance sheaths and ceramic stylets. DBS electrodes were identified in CT scans using Brainlab's lead localization tool. Trajectory and vector errors were quantified between scans for each lead in each patient. RESULTS Eighty patients with a total of 157 implanted DBS electrodes were included. We observed mean trajectory and vector errors of 0.78 ± 0.44 mm (range 0.1-2.0 mm) and 1.57 ± 0.79 mm (range 0.2-4.2 mm), respectively, between postoperative CT and intraoperative MRI. There were 7 patients with CT scans collected at multiple time points. Trajectory error increased by 0.15 ± 0.42 mm ( P = .31), and vector error increased by 0.22 ± 0.53 mm ( P = .13) in the later scans. Across all scans, there was no significant association between trajectory ( P = .053) or vector ( P = .98) error and the date of CT acquisition. DBS electrodes targeting the subthalamic nucleus had significantly greater trajectory errors ( P = .02) than those targeting the globus pallidus pars internus nucleus. CONCLUSION Commercially available software produced largely concordant lead localizations when comparing intraoperative MRIs with postoperative CT scans, with trajectory errors on average <1 mm. CT scans tend to be more comparable with intraoperative MRI in the immediate postoperative period, with increased time intervals associated with a greater magnitude of error between modalities.
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Affiliation(s)
- Alexander G Yearley
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Melissa Chua
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Andreas Horn
- Department of Neurology, Center for Brain Circuit Therapeutics, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - G Rees Cosgrove
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - John D Rolston
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Bower KL, Noecker AM, Reich M, McIntyre CC. Quantifying the Variability Associated with Postoperative Localization of Deep Brain Stimulation Electrodes. Stereotact Funct Neurosurg 2023; 101:277-284. [PMID: 37379823 PMCID: PMC10833063 DOI: 10.1159/000530462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 03/26/2023] [Indexed: 06/30/2023]
Abstract
INTRODUCTION Computational models of deep brain stimulation (DBS) have become common tools in clinical research studies that attempt to establish correlations between stimulation locations in the brain and behavioral outcome measures. However, the accuracy of any patient-specific DBS model depends heavily upon accurate localization of the DBS electrodes within the anatomy, which is typically defined via co-registration of clinical CT and MRI datasets. Several different approaches exist for this challenging registration problem, and each approach will result in a slightly different electrode localization. The goal of this study was to better understand how different processing steps (e.g., cost-function masking, brain extraction, intensity remapping) affect the estimate of the DBS electrode location in the brain. METHODS No "gold standard" exists for this kind of analysis, as the exact location of the electrode in the living human brain cannot be determined with existing clinical imaging approaches. However, we can estimate the uncertainty associated with the electrode position, which can be used to guide statistical analyses in DBS mapping studies. Therefore, we used high-quality clinical datasets from 10 subthalamic DBS subjects and co-registered their long-term postoperative CT with their preoperative surgical targeting MRI using 9 different approaches. The distances separating all of the electrode location estimates were calculated for each subject. RESULTS On average, electrodes were located within a median distance of 0.57 mm (0.49-0.74) of one another across the different registration approaches. However, when considering electrode location estimates from short-term postoperative CTs, the median distance increased to 2.01 mm (1.55-2.78). CONCLUSIONS The results of this study suggest that electrode location uncertainty needs to be factored into statistical analyses that attempt to define correlations between stimulation locations and clinical outcomes.
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Affiliation(s)
- Kelsey L. Bower
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH
| | - Angela M. Noecker
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH
| | - Martin Reich
- Department of Neurology, University of Wurzburg, Germany
| | - Cameron C. McIntyre
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH
- Department of Biomedical Engineering, Duke University, Durham, NC
- Department of Neurosurgery, Duke University, Durham, NC
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Reisert M, Sajonz BEA, Brugger TS, Reinacher PC, Russe MF, Kellner E, Skibbe H, Coenen VA. Where Position Matters-Deep-Learning-Driven Normalization and Coregistration of Computed Tomography in the Postoperative Analysis of Deep Brain Stimulation. Neuromodulation 2023; 26:302-309. [PMID: 36424266 DOI: 10.1016/j.neurom.2022.10.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 09/12/2022] [Accepted: 10/06/2022] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Recent developments in the postoperative evaluation of deep brain stimulation surgery on the group level warrant the detection of achieved electrode positions based on postoperative imaging. Computed tomography (CT) is a frequently used imaging modality, but because of its idiosyncrasies (high spatial accuracy at low soft tissue resolution), it has not been sufficient for the parallel determination of electrode position and details of the surrounding brain anatomy (nuclei). The common solution is rigid fusion of CT images and magnetic resonance (MR) images, which have much better soft tissue contrast and allow accurate normalization into template spaces. Here, we explored a deep-learning approach to directly relate positions (usually the lead position) in postoperative CT images to the native anatomy of the midbrain and group space. MATERIALS AND METHODS Deep learning is used to create derived tissue contrasts (white matter, gray matter, cerebrospinal fluid, brainstem nuclei) based on the CT image; that is, a convolution neural network (CNN) takes solely the raw CT image as input and outputs several tissue probability maps. The ground truth is based on coregistrations with MR contrasts. The tissue probability maps are then used to either rigidly coregister or normalize the CT image in a deformable way to group space. The CNN was trained in 220 patients and tested in a set of 80 patients. RESULTS Rigorous validation of such an approach is difficult because of the lack of ground truth. We examined the agreements between the classical and proposed approaches and considered the spread of implantation locations across a group of identically implanted subjects, which serves as an indicator of the accuracy of the lead localization procedure. The proposed procedure agrees well with current magnetic resonance imaging-based techniques, and the spread is comparable or even lower. CONCLUSIONS Postoperative CT imaging alone is sufficient for accurate localization of the midbrain nuclei and normalization to the group space. In the context of group analysis, it seems sufficient to have a single postoperative CT image of good quality for inclusion. The proposed approach will allow researchers and clinicians to include cases that were not previously suitable for analysis.
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Affiliation(s)
- Marco Reisert
- Department of Stereotactic and Functional Neurosurgery, Medical Center of Freiburg University, Freiburg, Germany; Medical Faculty of Freiburg University, Freiburg, Germany; Department of Diagnostic and Interventional Radiology, Medical Physics, Medical Center-University of Freiburg, Freiburg, Germany.
| | - Bastian E A Sajonz
- Department of Stereotactic and Functional Neurosurgery, Medical Center of Freiburg University, Freiburg, Germany; Medical Faculty of Freiburg University, Freiburg, Germany
| | - Timo S Brugger
- Department of Stereotactic and Functional Neurosurgery, Medical Center of Freiburg University, Freiburg, Germany; Medical Faculty of Freiburg University, Freiburg, Germany
| | - Peter C Reinacher
- Department of Stereotactic and Functional Neurosurgery, Medical Center of Freiburg University, Freiburg, Germany; Medical Faculty of Freiburg University, Freiburg, Germany; Fraunhofer Institute for Laser Technology, Aachen, Germany
| | - Maximilian F Russe
- Medical Faculty of Freiburg University, Freiburg, Germany; Department of Diagnostic and Interventional Radiology, Medical Physics, Medical Center-University of Freiburg, Freiburg, Germany
| | - Elias Kellner
- Medical Faculty of Freiburg University, Freiburg, Germany; Department of Diagnostic and Interventional Radiology, Medical Physics, Medical Center-University of Freiburg, Freiburg, Germany
| | - Henrik Skibbe
- RIKEN, Center for Brain Science, Brain Image Analysis Unit, Saitama, Japan
| | - Volker A Coenen
- Department of Stereotactic and Functional Neurosurgery, Medical Center of Freiburg University, Freiburg, Germany; Medical Faculty of Freiburg University, Freiburg, Germany; Center for Deep Brain Stimulation, Medical Center of Freiburg University, Freiburg, Germany
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Rusheen AE, Goyal A, Owen RL, Berning EM, Bothun DT, Giblon RE, Blaha CD, Welker KM, Huston J, Bennet KE, Oh Y, Fagan AJ, Lee KH. The development of ultra-high field MRI guidance technology for neuronavigation. J Neurosurg 2022; 137:1265-1277. [PMID: 35334465 PMCID: PMC10193481 DOI: 10.3171/2021.11.jns211078] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 11/19/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Magnetic resonance imaging at 7T offers improved image spatial and contrast resolution for visualization of small brain nuclei targeted in neuromodulation. However, greater image geometric distortion and a lack of compatible instrumentation preclude implementation. In this report, the authors detail the development of a stereotactic image localizer and accompanying imaging sequences designed to mitigate geometric distortion, enabling accurate image registration and surgical planning of basal ganglia nuclei. METHODS Magnetization-prepared rapid acquisition with gradient echo (MPRAGE), fast gray matter acquisition T1 inversion recovery (FGATIR), T2-weighted, and T2*-weighted sequences were optimized for 7T in 9 human subjects to visualize basal ganglia nuclei, minimize image distortion, and maximize target contrast-to-noise and signal-to-noise ratios. Extracranial spatial distortions were mapped to develop a skull-contoured image localizer embedded with spherical silicone fiducials for improved MR image registration and target guidance. Surgical plan accuracy testing was initially performed in a custom-developed MRI phantom (n = 5 phantom studies) and finally in a human trial. RESULTS MPRAGE and T2*-weighted sequences had the best measures among global measures of image quality (3.8/4, p < 0.0001; and 3.7/4, p = 0.0002, respectively). Among basal ganglia nuclei, FGATIR outperformed MPRAGE for globus pallidus externus (GPe) visualization (2.67/4 vs 1.78/4, p = 0.008), and FGATIR, T2-weighted imaging, and T2*-weighted imaging outperformed MPRAGE for substantia nigra visualization (1.44/4 vs 2.56/4, p = 0.04; vs 2.56/4, p = 0.04; vs 2.67/4, p = 0.003). Extracranial distortion was lower in the head's midregion compared with the base and apex ( 1.17-1.33 mm; MPRAGE and FGATIR, p < 0.0001; T2-weighted imaging, p > 0.05; and T2*-weighted imaging, p = 0.013). Fiducial placement on the localizer in low distortion areas improved image registration (fiducial registration error, 0.79-1.19 mm; p < 0.0001) and targeting accuracy (target registration error, 0.60-1.09 mm; p = 0.04). Custom surgical software and the refined image localizer enabled successful surgical planning in a human trial (fiducial registration error = 1.0 mm). CONCLUSIONS A skull-contoured image localizer that accounts for image distortion is necessary to enable high-accuracy 7T imaging-guided targeting for surgical neuromodulation. These results may enable improved clinical efficacy for the treatment of neurological disease.
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Affiliation(s)
- Aaron E. Rusheen
- Department of Neurologic Surgery, Mayo Clinic, Rochester
- Medical Scientist Training Program, Mayo Clinic, Rochester
| | - Abhinav Goyal
- Department of Neurologic Surgery, Mayo Clinic, Rochester
- Medical Scientist Training Program, Mayo Clinic, Rochester
| | - Robert L. Owen
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester
| | | | - Dane T. Bothun
- Department of Neurologic Surgery, Mayo Clinic, Rochester
| | - Rachel E. Giblon
- Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester
| | | | | | - John Huston
- Department of Radiology, Mayo Clinic, Rochester; and
| | | | - Yoonbae Oh
- Department of Neurologic Surgery, Mayo Clinic, Rochester
| | - Andrew J. Fagan
- Department of Radiology, Mayo Clinic, Rochester; and
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota
| | - Kendall H. Lee
- Department of Neurologic Surgery, Mayo Clinic, Rochester
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota
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Tasserie J, Lozano AM. Editorial. 7T MRI for neuronavigation: toward better visualization during functional surgery. J Neurosurg 2022; 137:1262-1263. [PMID: 35334461 DOI: 10.3171/2021.12.jns212655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Pu JJ, Choi WS, Yang WF, Zhu WY, Su YX. Unexpected Change of Surgical Plans and Contingency Strategies in Computer-Assisted Free Flap Jaw Reconstruction: Lessons Learned From 98 Consecutive Cases. Front Oncol 2022; 12:746952. [PMID: 35186723 PMCID: PMC8854356 DOI: 10.3389/fonc.2022.746952] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 01/17/2022] [Indexed: 12/17/2022] Open
Abstract
BackgroundComputer-assisted surgeries (CAS) are increasingly being adopted as the treatment of choice for jaw reconstructions with osseous free flaps. Although unexpected change of surgical plans remains a major concern of CAS, there are few studies focusing on this unfavorable clinical scenario. The aim of the present study was to investigate the rate of unexpected change of surgical plans and potential influential parameters, and to discuss the contingency strategies.MethodsA retrospective study was performed to evaluate all the patients who underwent computer-assisted jaw resections and osseous free flap reconstructions. The postoperative radiographs were reviewed and compared with the preoperative surgical plans. Operating records were examined to analyze the reasons for unexpected change of surgical plans and the management. The potential influential parameters for the change of surgical plans were analyzed using Fisher-exact test. The difference was regarded as statistically significant for a p-value less than 5%.ResultsFrom Nov 2014 to Oct 2021, a total of 98 consecutive computer-assisted free flap jaw reconstruction cases with osseous free flaps were included in this study. Our experience showed that 5.1% of the patients (five cases) needed intra-operative change of the surgical plans. We summarized the unexpected change of surgical plans and the contingency strategies as four clinical scenarios, including extended resection and reconstruction, shortened resection and reconstruction, modified resection without changing reconstruction, and modified reconstruction without changed resection. None of the potential influential parameters was identified as significant in relation to unexpected change of surgical plans intraoperatively.ConclusionOur experience shows that with the comprehensive methodology for computer-assisted free flap jaw reconstruction surgery planning, we can minimize the possibility of unexpected change of surgical plans during surgery. The lessons learned from our 98 consecutive cases can help beginners prevent unexpected change of surgical plans and rationalize contingency strategies in computer-assisted free flap jaw reconstruction.
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Malatt C, Tagliati M. Long-Term Outcomes of Deep Brain Stimulation for Pediatric Dystonia. Pediatr Neurosurg 2022; 57:225-237. [PMID: 35439762 DOI: 10.1159/000524577] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 04/06/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Deep brain stimulation (DBS) has been utilized for over two decades to treat medication-refractory dystonia in children. Short-term benefit has been demonstrated for inherited, isolated, and idiopathic cases, with less efficacy in heredodegenerative and acquired dystonia. The ongoing publication of long-term outcomes warrants a critical assessment of available information as pediatric patients are expected to live most of their lives with these implants. SUMMARY We performed a review of the literature for data describing motor and neuropsychiatric outcomes, in addition to complications, 5 or more years after DBS placement in patients undergoing DBS surgery for dystonia at an age younger than 21. We identified 20 articles including individual data on long-term motor outcomes after DBS for a total of 78 patients. In addition, we found five articles reporting long-term outcomes after DBS in 9 patients with status dystonicus. Most patients were implanted within the globus pallidus internus, with only a few cases targeting the subthalamic nucleus and ventrolateral posterior nucleus of the thalamus. The average follow-up was 8.5 years, with a range of up to 22 years. Long-term outcomes showed a sustained motor benefit, with median Burke-Fahn-Marsden dystonia rating score improvement ranging from 2.5% to 93.2% in different dystonia subtypes. Patients with inherited, isolated, and idiopathic dystonias had greater improvement than those with heredodegenerative and acquired dystonias. Sustained improvements in quality of life were also reported, without the development of significant cognitive or psychiatric comorbidities. Late adverse events tended to be hardware-related, with minimal stimulation-induced effects. KEY MESSAGES While data regarding long-term outcomes is somewhat limited, particularly with regards to neuropsychiatric outcomes and adverse events, improvement in motor outcomes appears to be preserved more than 5 years after DBS placement.
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Affiliation(s)
- Camille Malatt
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, California, USA,
| | - Michele Tagliati
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, California, USA
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He C, Zhang F, Li L, Jiang C, Li L. Measurement of Lead Localization Accuracy Based on Magnetic Resonance Imaging. Front Neurosci 2021; 15:632822. [PMID: 35002596 PMCID: PMC8727439 DOI: 10.3389/fnins.2021.632822] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 11/04/2021] [Indexed: 11/13/2022] Open
Abstract
Post-implantation localization of deep brain stimulation (DBS) lead based on a magnetic resonance (MR) image is widely used. Existing localization methods use artifact center method or template registration method, which may lead to a considerable deviation of > 2 mm, and result in severe side effects or even surgical failure. Accurate measurement of lead position can instantly inform surgeons of the imprecise implantation. This study aimed to identify the influencing factors in DBS lead post-implantation localization approach, analyze their influence, and describe a localization approach that uses the individual template method to reduce the deviation. We verified that reconstructing direction should be parallel or perpendicular to lead direction, instead of the magnetic field. Besides, we used simplified relationship between magnetic field angle and deviation error to correct the localization results. The mean localization error can be reduced after correction and favors the feasibility of direct localization of DBS lead using MR images. We also discussed influence of in vivo noise on localization frequency and the possibility of using only MR images to localize the contacts.
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Affiliation(s)
- Changgeng He
- National Engineering Laboratory for Neuromodulation, School of Aerospace Engineering, Tsinghua University, Beijing, China
| | - Feng Zhang
- National Engineering Laboratory for Neuromodulation, School of Aerospace Engineering, Tsinghua University, Beijing, China
| | - Linze Li
- National Engineering Laboratory for Neuromodulation, School of Aerospace Engineering, Tsinghua University, Beijing, China
| | - Changqing Jiang
- National Engineering Laboratory for Neuromodulation, School of Aerospace Engineering, Tsinghua University, Beijing, China
| | - Luming Li
- National Engineering Laboratory for Neuromodulation, School of Aerospace Engineering, Tsinghua University, Beijing, China
- Precision Medicine and Healthcare Research Center, Tsinghua-Berkeley Shenzhen Institute, Tsinghua University, Shenzhen, China
- IDG/McGovern Institute for Brain Research at Tsinghua University, Beijing, China
- Institute of Epilepsy, Beijing Institute for Brain Disorders, Beijing, China
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Engelhardt J, Cuny E, Guehl D, Burbaud P, Damon-Perrière N, Dallies-Labourdette C, Thomas J, Branchard O, Schmitt LA, Gassa N, Zemzemi N. Prediction of Clinical Deep Brain Stimulation Target for Essential Tremor From 1.5 Tesla MRI Anatomical Landmarks. Front Neurol 2021; 12:620360. [PMID: 34777189 PMCID: PMC8579860 DOI: 10.3389/fneur.2021.620360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 09/13/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Deep brain stimulation is an efficacious treatment for refractory essential tremor, though targeting the intra-thalamic nuclei remains challenging. Objectives: We sought to develop an inverse approach to retrieve the position of the leads in a cohort of patients operated on with optimal clinical outcomes from anatomical landmarks identifiable by 1.5 Tesla magnetic resonance imaging. Methods: The learning database included clinical outcomes and post-operative imaging from which the coordinates of the active contacts and those of anatomical landmarks were extracted. We used machine learning regression methods to build three different prediction models. External validation was performed according to a leave-one-out cross-validation. Results: Fifteen patients (29 leads) were included, with a median tremor improvement of 72% on the Fahn-Tolosa-Marin scale. Kernel ridge regression, deep neural networks, and support vector regression (SVR) were used. SVR gave the best results with a mean error of 1.33 ± 1.64 mm between the predicted target and the active contact position. Conclusion: We report an original method for the targeting in deep brain stimulation for essential tremor based on patients' radio-anatomical features. This approach will be tested in a prospective clinical trial.
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Affiliation(s)
- Julien Engelhardt
- Department of Neurosurgery, University Hospital of Bordeaux, Bordeaux, France.,Institute for Neurodegenerative Disorders, CNRS-University of Bordeaux, Bordeaux, France
| | - Emmanuel Cuny
- Department of Neurosurgery, University Hospital of Bordeaux, Bordeaux, France.,Institute for Neurodegenerative Disorders, CNRS-University of Bordeaux, Bordeaux, France
| | - Dominique Guehl
- Institute for Neurodegenerative Disorders, CNRS-University of Bordeaux, Bordeaux, France.,Department of Neurology, University Hospital of Bordeaux, Bordeaux, France
| | - Pierre Burbaud
- Institute for Neurodegenerative Disorders, CNRS-University of Bordeaux, Bordeaux, France.,Department of Neurology, University Hospital of Bordeaux, Bordeaux, France
| | - Nathalie Damon-Perrière
- Institute for Neurodegenerative Disorders, CNRS-University of Bordeaux, Bordeaux, France.,Department of Neurology, University Hospital of Bordeaux, Bordeaux, France
| | - Camille Dallies-Labourdette
- Institute for Neurodegenerative Disorders, CNRS-University of Bordeaux, Bordeaux, France.,Department of Neurology, University Hospital of Bordeaux, Bordeaux, France
| | - Juliette Thomas
- Institute for Neurodegenerative Disorders, CNRS-University of Bordeaux, Bordeaux, France.,Department of Neurology, University Hospital of Bordeaux, Bordeaux, France
| | - Olivier Branchard
- Department of Neurosurgery, University Hospital of Bordeaux, Bordeaux, France
| | | | - Narimane Gassa
- INRIA Bordeaux Sud-Ouest Research Centre, Talence, France
| | - Nejib Zemzemi
- INRIA Bordeaux Sud-Ouest Research Centre, Talence, France.,Mathematical Institute of Bordeaux, University of Bordeaux, Bordeaux, France
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12
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Merola A, Singh J, Reeves K, Changizi B, Goetz S, Rossi L, Pallavaram S, Carcieri S, Harel N, Shaikhouni A, Sammartino F, Krishna V, Verhagen L, Dalm B. New Frontiers for Deep Brain Stimulation: Directionality, Sensing Technologies, Remote Programming, Robotic Stereotactic Assistance, Asleep Procedures, and Connectomics. Front Neurol 2021; 12:694747. [PMID: 34367055 PMCID: PMC8340024 DOI: 10.3389/fneur.2021.694747] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 06/14/2021] [Indexed: 11/21/2022] Open
Abstract
Over the last few years, while expanding its clinical indications from movement disorders to epilepsy and psychiatry, the field of deep brain stimulation (DBS) has seen significant innovations. Hardware developments have introduced directional leads to stimulate specific brain targets and sensing electrodes to determine optimal settings via feedback from local field potentials. In addition, variable-frequency stimulation and asynchronous high-frequency pulse trains have introduced new programming paradigms to efficiently desynchronize pathological neural circuitry and regulate dysfunctional brain networks not responsive to conventional settings. Overall, these innovations have provided clinicians with more anatomically accurate programming and closed-looped feedback to identify optimal strategies for neuromodulation. Simultaneously, software developments have simplified programming algorithms, introduced platforms for DBS remote management via telemedicine, and tools for estimating the volume of tissue activated within and outside the DBS targets. Finally, the surgical accuracy has improved thanks to intraoperative magnetic resonance or computerized tomography guidance, network-based imaging for DBS planning and targeting, and robotic-assisted surgery for ultra-accurate, millimetric lead placement. These technological and imaging advances have collectively optimized DBS outcomes and allowed “asleep” DBS procedures. Still, the short- and long-term outcomes of different implantable devices, surgical techniques, and asleep vs. awake procedures remain to be clarified. This expert review summarizes and critically discusses these recent innovations and their potential impact on the DBS field.
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Affiliation(s)
- Aristide Merola
- Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Jaysingh Singh
- Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Kevin Reeves
- Department of Psychiatry, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Barbara Changizi
- Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Steven Goetz
- Medtronic PLC Neuromodulation, Minneapolis, MN, United States
| | | | | | | | - Noam Harel
- Center for Magnetic Resonance Research, University of Minnesota Medical School, Minneapolis, MN, United States
| | - Ammar Shaikhouni
- Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Francesco Sammartino
- Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Vibhor Krishna
- Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Leo Verhagen
- Movement Disorder Section, Department of Neurological Sciences, Rush University, Chicago, IL, United States
| | - Brian Dalm
- Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, OH, United States
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13
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Chandran AS, Thani NB, Bangash OK, Lind CRP. The Magnetic Resonance Imaging (MRI)-Directed Implantable Guide Tube Technique: Accuracy and Applications in Deep Brain Stimulation. World Neurosurg 2021; 151:e1016-e1023. [PMID: 34044164 DOI: 10.1016/j.wneu.2021.05.048] [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: 02/28/2021] [Revised: 05/11/2021] [Accepted: 05/13/2021] [Indexed: 09/30/2022]
Abstract
OBJECTIVE The magnetic resonance imaging (MRI)-directed implantable guide tube technique allows for direct targeting of deep brain structures without microelectrode recording or intraoperative clinical assessment. This study describes a 10-year institutional experience of this technique including nuances that enable performance of surgery using readily available equipment. METHODS Eighty-seven patients underwent deep brain stimulation surgery using the guide tube technique for Parkinson disease (n = 59), essential tremor (n = 16), and dystonia (n = 12). Preoperative and intraoperative MRI was analyzed to measure lead accuracy, volume of pneumocephalus, and the ability to safely plan a trajectory for multiple electrode contacts. RESULTS Mean target error was measured to be 0.7 mm (95% confidence interval [CI] 0.6-0.8 mm) in the anteroposterior plane, 0.6 mm (95% CI 0.5-0.7 mm) in the mediolateral plane, and 0.8 mm (95% CI 0.7-0.9 mm) in the superoinferior plane. Net deviation (Euclidean error) from the planned target was 1.3 mm (95% CI 1.2-1.4 mm). Mean intracranial air volume per lead was 0.2 mL (95% CI 0.1-0.4 mL). In total, 52 patients had no intracranial air on postoperative imaging. In all patients, a safe trajectory could be planned to target for multiple electrode contacts without violating critical neural structures, the lateral ventricle, sulci, or cerebral blood vessels. CONCLUSIONS The MRI-directed implantable guide tube technique is a highly accurate, low-cost, reliable method for introducing deep brain electrodes. This technique reduces brain shift secondary to pneumocephalus and allows for whole trajectory planning of multiple electrode contacts.
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Affiliation(s)
- Arjun S Chandran
- Department of Neurosurgery, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.
| | - Nova B Thani
- Department of Neurosurgery, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Omar K Bangash
- Department of Neurosurgery, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Christopher R P Lind
- Department of Neurosurgery, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia; School of Medicine, University of Western Australia, Perth, Western Australia, Australia
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14
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Burke JF, Tanzillo D, Starr PA, Lim DA, Larson PS. CT and MRI Image Fusion Error: An Analysis of Co-Registration Error Using Commercially Available Deep Brain Stimulation Surgical Planning Software. Stereotact Funct Neurosurg 2021; 99:196-202. [PMID: 33535219 DOI: 10.1159/000511114] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 08/24/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION During deep brain stimulation (DBS) surgery, computed tomography (CT) and magnetic resonance imaging (MRI) scans need to be co-registered or fused. Image fusion is associated with the error that can distort the location of anatomical structures. Co-registration in DBS surgery is usually performed automatically by proprietary software; the amount of error during this process is not well understood. Here, our goal is to quantify the error during automated image co-registration with FrameLink™, a commonly used software for DBS planning and clinical research. METHODS This is a single-center retrospective study at a quaternary care referral center, comparing CT and MR imaging co-registration for a consecutive series of patients over a 12-month period. We collected CT images and MRI scans for 22 patients with Parkinson's disease requiring placement of DBS. Anatomical landmarks were located on CT images and MRI scans using a novel image analysis algorithm that included a method for capturing the potential error inherent in the image standardization step of the analysis. The distance between the anatomical landmarks was measured, and the error was found by averaging the distances across all patients. RESULTS The average error during co-registration was 1.25 mm. This error was significantly larger than the error resulting from image standardization (0.19 mm) and was worse in the anterior-posterior direction. CONCLUSIONS The image fusion errors found in this analysis were nontrivial. Although the estimated error may be inflated, it is sig-nificant enough that users must be aware of this potential inaccuracy, and developers of proprietary software should provide details about the magnitude and direction of co-registration errors.
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Affiliation(s)
- John F Burke
- Department of Neurological Surgery, University of California, San Francisco, California, USA,
| | | | - Philip A Starr
- Department of Neurological Surgery, University of California, San Francisco, California, USA.,Surgical Service, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Daniel A Lim
- Department of Neurological Surgery, University of California, San Francisco, California, USA.,Surgical Service, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Paul S Larson
- Department of Neurological Surgery, University of California, San Francisco, California, USA.,Surgical Service, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
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15
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Hu LH, Zhang WB, Yu Y, Peng X. Accuracy of multimodal image fusion for oral and maxillofacial tumors: A revised evaluation method and its application. J Craniomaxillofac Surg 2020; 48:741-750. [PMID: 32536539 DOI: 10.1016/j.jcms.2020.05.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 05/14/2020] [Accepted: 05/28/2020] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To develop a revised evaluation method for accuracy of multimodal image fusion for oral and maxillofacial tumors and explore its application for comparing the accuracy of three commonly used fusion algorithms, automatic fusion, manual fusion, and registration point-based fusion. MATERIALS AND METHODS Image sets of patients with oral and maxillofacial tumor were fused using the iPlan 3.0 navigation system. Fusion accuracy included two aspects: (1) overall fusion accuracy: represented by the mean value of the coordinate differences along the x-, y-, and z- axes (Δx, Δy, and Δz), mean deviation (MD), and root mean square (RMS) of six pairs of landmarks on the two image sets; (2) tumor volume fusion accuracy: represented by Fusion Index (FI), which was calculated based on the volume of tumor delineated on the two image sets. RESULTS Eighteen pairs of image sets of 17 patients were enrolled in this study. The Δx and Δy values for the three algorithms were less than 1.5 mm. The Δz values for automatic fusion, manual fusion and registration point-based fusion was 1.049 mm, 1.864 mm and 1.254 mm. The MD for automatic fusion, manual fusion and registration point-based fusion was 1.978 mm, 2.788 mm and 1.926 mm. Significant differences existed in Δz for manual fusion and that for automatic fusion (P = 0.058), in MD for manual fusion and that for automatic fusion (P = 0.087), and in MD for manual fusion and that for registration point-based fusion (P = 0.069). The FI for automatic fusion, manual fusion, and registration point-based fusion was 0.594, 0.520, and 0.549; the inter-algorithm differences were not significant (P = 0.290). CONCLUSION The automatic fusion and the registration point-based fusion were more accurate than manual fusion, and therefore were recommended to be used in multimodal image fusion for oral and maxillofacial tumors.
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Affiliation(s)
- Lei-Hao Hu
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, 22# Zhongguancun South Avenue, Beijing 100081, China.
| | - Wen-Bo Zhang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, 22# Zhongguancun South Avenue, Beijing 100081, China.
| | - Yao Yu
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, 22# Zhongguancun South Avenue, Beijing 100081, China.
| | - Xin Peng
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, 22# Zhongguancun South Avenue, Beijing 100081, China.
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16
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Yang R, Lu H, Wang Y, Peng X, Mao C, Yi Z, Guo Y, Guo C. CT-MRI Image Fusion-Based Computer-Assisted Navigation Management of Communicative Tumors Involved the Infratemporal-Middle Cranial Fossa. J Neurol Surg B Skull Base 2020; 82:e321-e329. [PMID: 34306956 DOI: 10.1055/s-0040-1701603] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 12/24/2019] [Indexed: 01/02/2023] Open
Abstract
Objective Computed tomography (CT) and magnetic resonance imaging (MRI) are crucial for preoperative assessment of the three-dimensional (3D) spatial position relationships of tumor, vital vessels, brain tissue, and craniomaxillofacial bones precisely. The value of CT-MRI-based image fusion was explored for the preoperative assessment, virtual planning, and navigation surgery application during the treatment of communicative tumors involved the infratemporal fossa (ITF) and middle cranial fossa. Methods Eight patients with infratemporal-middle cranial fossa communicative tumors (ICFCTs) were enrolled in this retrospective study. Plain CT, contrast CT, and MRI image data were imported into a workstation for image fusion, which were used for 3D image reconstruction, virtual surgical planning, and intraoperative navigation sequentially. Therapeutic effect was evaluated through the clinical data analysis of ICFCT patients after CT-MRI image fusion-based navigation-guided biopsy or surgery. Results High-quality CT-MRI image fusion and 3D reconstruction were obtained in all eight cases. Image fusion combined with 3D image reconstruction enhanced the preoperative assessment of ICFCT, and improved the surgical performance via virtual planning. Definite pathological diagnosis was obtained in all four navigation-guided core needle biopsies. Complete removal of the tumor was achieved with one exception among the seven navigation-guided operations. Postoperative cerebrospinal fluid leakage occurred in one patient with recurrent meningioma. Conclusion CT-MRI image fusion combined with computer-assisted navigation management, optimized the accuracy, safety, and surgical results for core needle biopsy and surgery of ICFCTs.
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Affiliation(s)
- Rong Yang
- National Clinical Research Center for Oral Diseases, Beijing, P.R. China.,National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, P.R. China.,Beijing Key Laboratory of Digital Stomatology, Beijing, P.R. China.,Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, P.R. China
| | - Han Lu
- National Clinical Research Center for Oral Diseases, Beijing, P.R. China.,National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, P.R. China.,Beijing Key Laboratory of Digital Stomatology, Beijing, P.R. China.,Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, P.R. China
| | - Yang Wang
- National Clinical Research Center for Oral Diseases, Beijing, P.R. China.,National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, P.R. China.,Beijing Key Laboratory of Digital Stomatology, Beijing, P.R. China.,Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, P.R. China
| | - Xin Peng
- National Clinical Research Center for Oral Diseases, Beijing, P.R. China.,National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, P.R. China.,Beijing Key Laboratory of Digital Stomatology, Beijing, P.R. China.,Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, P.R. China
| | - Chi Mao
- National Clinical Research Center for Oral Diseases, Beijing, P.R. China.,National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, P.R. China.,Beijing Key Laboratory of Digital Stomatology, Beijing, P.R. China.,Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, P.R. China
| | - Zhiqiang Yi
- Department of Neurosurgery, Peking University First Hospital, Beijing, P.R. China
| | - Yuxing Guo
- National Clinical Research Center for Oral Diseases, Beijing, P.R. China.,National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, P.R. China.,Beijing Key Laboratory of Digital Stomatology, Beijing, P.R. China.,Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, P.R. China
| | - Chuanbin Guo
- National Clinical Research Center for Oral Diseases, Beijing, P.R. China.,National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, P.R. China.,Beijing Key Laboratory of Digital Stomatology, Beijing, P.R. China.,Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, P.R. China
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17
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Lu L, Fu X, Liew Y, Zhang Y, Zhao S, Xu Z, Zhao J, Li D, Li Q, Stanley GB, Duan X. Soft and MRI Compatible Neural Electrodes from Carbon Nanotube Fibers. NANO LETTERS 2019; 19:1577-1586. [PMID: 30798604 DOI: 10.1021/acs.nanolett.8b04456] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Soft and magnetic resonance imaging (MRI) compatible neural electrodes enable stable chronic electrophysiological measurements and anatomical or functional MRI studies of the entire brain without electrode interference with MRI images. These properties are important for many studies, ranging from a fundamental neurophysiological study of functional MRI signals to a chronic neuromodulatory effect investigation of therapeutic deep brain stimulation. Here we develop soft and MRI compatible neural electrodes using carbon nanotube (CNT) fibers with a diameter from 20 μm down to 5 μm. The CNT fiber electrodes demonstrate excellent interfacial electrochemical properties and greatly reduced MRI artifacts than PtIr electrodes under a 7.0 T MRI scanner. With a shuttle-assisted implantation strategy, we show that the soft CNT fiber electrodes can precisely target specific brain regions and record high-quality single-unit neural signals. Significantly, they are capable of continuously detecting and isolating single neuronal units from rats for up to 4-5 months without electrode repositioning, with greatly reduced brain inflammatory responses as compared to their stiff metal counterparts. In addition, we show that due to their high tensile strength, the CNT fiber electrodes can be retracted controllably postinsertion, which provides an effective and convenient way to do multidepth recording or potentially selecting cells with particular response properties. The chronic recording stability and MRI compatibility, together with their small size, provide the CNT fiber electrodes unique research capabilities for both basic and applied neuroscience studies.
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Affiliation(s)
- Linlin Lu
- Department of Biomedical Engineering, College of Engineering , Peking University , Beijing 100871 , China
- Wallace H. Coulter Department of Biomedical Engineering , Georgia Institute of Technology and Emory University , Atlanta , Georgia 30332 , United States
| | - Xuefeng Fu
- Department of Biomedical Engineering, College of Engineering , Peking University , Beijing 100871 , China
| | - Yijuin Liew
- Wallace H. Coulter Department of Biomedical Engineering , Georgia Institute of Technology and Emory University , Atlanta , Georgia 30332 , United States
| | - Yongyi Zhang
- Suzhou Institute of Nano-Tech and Nano-Bionics (SINANO), Chinese Academy of Sciences , Suzhou 215123 , China
| | - Siyuan Zhao
- Department of Biomedical Engineering, College of Engineering , Peking University , Beijing 100871 , China
- Academy for Advanced Interdisciplinary Studies , Peking University , Beijing 100871 , China
| | - Zheng Xu
- Department of Biomedical Engineering, College of Engineering , Peking University , Beijing 100871 , China
| | - Jingna Zhao
- Suzhou Institute of Nano-Tech and Nano-Bionics (SINANO), Chinese Academy of Sciences , Suzhou 215123 , China
| | - Da Li
- Suzhou Institute of Nano-Tech and Nano-Bionics (SINANO), Chinese Academy of Sciences , Suzhou 215123 , China
| | - Qingwen Li
- Suzhou Institute of Nano-Tech and Nano-Bionics (SINANO), Chinese Academy of Sciences , Suzhou 215123 , China
| | - Garrett B Stanley
- Wallace H. Coulter Department of Biomedical Engineering , Georgia Institute of Technology and Emory University , Atlanta , Georgia 30332 , United States
| | - Xiaojie Duan
- Department of Biomedical Engineering, College of Engineering , Peking University , Beijing 100871 , China
- Academy for Advanced Interdisciplinary Studies , Peking University , Beijing 100871 , China
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18
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Kremer NI, Oterdoom DLM, van Laar PJ, Piña-Fuentes D, van Laar T, Drost G, van Hulzen ALJ, van Dijk JMC. Accuracy of Intraoperative Computed Tomography in Deep Brain Stimulation-A Prospective Noninferiority Study. Neuromodulation 2019; 22:472-477. [PMID: 30629330 PMCID: PMC6618091 DOI: 10.1111/ner.12918] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 11/04/2018] [Accepted: 11/30/2018] [Indexed: 01/09/2023]
Abstract
Introduction Clinical response to deep brain stimulation (DBS) strongly depends on the appropriate placement of the electrode in the targeted structure. Postoperative MRI is recognized as the gold standard to verify the DBS‐electrode position in relation to the intended anatomical target. However, intraoperative computed tomography (iCT) might be a feasible alternative to MRI. Materials and Methods In this prospective noninferiority study, we compared iCT with postoperative MRI (24‐72 hours after surgery) in 29 consecutive patients undergoing placement of 58 DBS electrodes. The primary outcome was defined as the difference in Euclidean distance between lead tip coordinates as determined on both imaging modalities, using the lead tip depicted on MRI as reference. Secondary outcomes were difference in radial error and depth, as well as difference in accuracy relative to target. Results The mean difference between the lead tips was 0.98 ± 0.49 mm (0.97 ± 0.47 mm for the left‐sided electrodes and 1.00 ± 0.53 mm for the right‐sided electrodes). The upper confidence interval (95% CI, 0.851 to 1.112) did not exceed the noninferiority margin established. The average radial error between lead tips was 0.74 ± 0.48 mm and the average depth error was determined to be 0.53 ± 0.40 mm. The linear Deming regression indicated a good agreement between both imaging modalities regarding accuracy relative to target. Conclusions Intraoperative CT is noninferior to MRI for the verification of the DBS‐electrode position. CT and MRI have their specific benefits, but both should be considered equally suitable for assessing accuracy.
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Affiliation(s)
- Naomi I Kremer
- Department of Neurosurgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - D L Marinus Oterdoom
- Department of Neurosurgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Peter Jan van Laar
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Dan Piña-Fuentes
- Department of Neurosurgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Teus van Laar
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Gea Drost
- Department of Neurosurgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Arjen L J van Hulzen
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - J Marc C van Dijk
- Department of Neurosurgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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19
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Engelhardt J, Guehl D, Damon-Perrière N, Branchard O, Burbaud P, Cuny E. Localization of Deep Brain Stimulation Electrode by Image Registration Is Software Dependent: A Comparative Study between Four Widely Used Software Programs. Stereotact Funct Neurosurg 2018; 96:364-369. [PMID: 30566953 DOI: 10.1159/000494982] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 10/24/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND The control of the anatomic position of the active contacts is essential to understand the effects and adapt the settings of the neurostimulation. The localization is commonly assessed by a registration between the preoperative MRI and the postoperative CT scan. However, its accuracy depends on the quality of the registration algorithm and many software programs are available. OBJECTIVE To compare the localization of implanted deep brain stimulation (DBS) leads in the subthalamic nucleus (STN) between four registration devices. METHODS The preoperative stereotactic MRI was co-registered and fused with the 3-month postoperative CT scan in 27 patients implanted in the STN for Parkinson's disease (53 leads). Localizations of the active contacts were calculated in the stereotactic frame space and compared between software programs. RESULTS The coordinates of the active contacts were different between software programs in the 3 axes (p < 0.001) with a mean vectorial error between the deepest contact locations of 1.17 mm (95% CI 1.09-1.25). CONCLUSION We found a small but significant difference in the coordinates calculated on four different devices. These results have to be considered when performing studies comparing active contact locations or when following patients with an implanted DBS lead.
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Affiliation(s)
- Julien Engelhardt
- CHU de Bordeaux, Service de neurochirurgie B, Bordeaux, France, .,Université de Bordeaux, Institut des maladies neurodégénératives, UMR 5293, Bordeaux, France,
| | - Dominique Guehl
- Université de Bordeaux, Institut des maladies neurodégénératives, UMR 5293, Bordeaux, France.,CHU de Bordeaux, Service d'explorations fonctionnelles du système nerveux, Bordeaux, France
| | - Nathalie Damon-Perrière
- Université de Bordeaux, Institut des maladies neurodégénératives, UMR 5293, Bordeaux, France.,CHU de Bordeaux, Service d'explorations fonctionnelles du système nerveux, Bordeaux, France
| | | | - Pierre Burbaud
- Université de Bordeaux, Institut des maladies neurodégénératives, UMR 5293, Bordeaux, France.,CHU de Bordeaux, Service d'explorations fonctionnelles du système nerveux, Bordeaux, France
| | - Emmanuel Cuny
- CHU de Bordeaux, Service de neurochirurgie B, Bordeaux, France.,Université de Bordeaux, Institut des maladies neurodégénératives, UMR 5293, Bordeaux, France
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20
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Ellenbogen J, Tuura R, Ashkan K. Localisation of DBS Electrodes Post-Implantation, to CT or MRI? Which Is the Best Option? Stereotact Funct Neurosurg 2018; 96:347-348. [DOI: 10.1159/000493576] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 09/09/2018] [Indexed: 11/19/2022]
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21
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Reduction of Artifacts Caused by Deep Brain Stimulating Electrodes in Cranial Computed Tomography Imaging by Means of Virtual Monoenergetic Images, Metal Artifact Reduction Algorithms, and Their Combination. Invest Radiol 2018; 53:424-431. [DOI: 10.1097/rli.0000000000000460] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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22
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Ranjan M, Boutet A, Xu DS, Lozano CS, Kumar R, Fasano A, Kucharczyk W, Lozano AM. Subthalamic Nucleus Visualization on Routine Clinical Preoperative MRI Scans: A Retrospective Study of Clinical and Image Characteristics Predicting Its Visualization. Stereotact Funct Neurosurg 2018; 96:120-126. [PMID: 29847826 DOI: 10.1159/000488397] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 03/05/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND The visualization of the subthalamic nucleus (STN) on magnetic resonance imaging (MRI) is variable. Studies of the contribution of patient-related factors and intrinsic brain volumetrics to STN visualization have not been reported previously. OBJECTIVE To assess the visualization of the STN during deep brain stimulation (DBS) surgery in a clinical setting. METHODS Eighty-two patients undergoing pre-operative MRI to plan for STN DBS for Parkinson disease were retrospectively studied. The visualization of the STN and its borders was assessed and scored by 3 independent observers using a 4-point ordinal scale (from 0 = not seen to 3 = excellent visualization). This measure was then correlated with the patients' clinical information and brain volumes. RESULTS The mean STN visualization scores were 1.68 and 1.63 for the right and left STN, respectively, with a good interobserver reliability (intraclass correlation coefficient: 0.744). Older age and decreased white matter volume were negatively correlated with STN visualization (p < 0.05). CONCLUSION STN visualization is only fair to good on routine MRI with good concordance of interindividual rating. Advancing age and decreased white matter are associated with poor visualization of the STN. Knowledge about factors contributing to poor visualization of the STN could alert a surgeon to modify the imaging strategy to optimize surgical targeting.
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Affiliation(s)
- Manish Ranjan
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Alexandre Boutet
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - David S Xu
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Christopher S Lozano
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Rajeev Kumar
- Marine Institute, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
| | - Alfonso Fasano
- Morton and Gloria Shulman Movement Disorders Centre and Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital, UHN, Toronto, Ontario, Canada.,Division of Neurology, University of Toronto, Toronto, Ontario, Canada.,Krembil Research Institute, Toronto, Ontario, Canada
| | - Walter Kucharczyk
- Division of Neuroimaging, Department of Medical Imaging, Toronto, Ontario, Canada
| | - Andres M Lozano
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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Xia J, He P, Cai X, Zhang D, Xie N. Magnetic resonance and computed tomography image fusion technology in patients with Parkinson's disease after deep brain stimulation. J Neurol Sci 2017; 381:250-255. [PMID: 28991693 DOI: 10.1016/j.jns.2017.08.3267] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 08/31/2017] [Accepted: 08/31/2017] [Indexed: 10/18/2022]
Abstract
Electrode position after deep brain stimulation (DBS) for Parkinson's disease (PD) needs to be confirmed, but there are concerns about the risk of postoperative magnetic resonance imaging (MRI) after DBS. These issues could be avoided by fusion images obtained from preoperative MRI and postoperative computed tomography (CT). This study aimed to investigate image fusion technology for displaying the position of the electrodes compared with postoperative MRI. This was a retrospective study of 32 patients with PD treated with bilateral subthalamic nucleus (STN) DBS between April 2015 and March 2016. The postoperative (same day) CT and preoperative MRI were fused using the Elekta Leksell 10.1 planning workstation (Elekta Instruments, Stockholm, Sweden). The position of the electrodes was compared between the fusion images and postoperative 1-2-week MRI. The position of the electrodes was highly correlated between the fusion and postoperative MRI (all r between 0.865 and 0.996; all P<0.001). The differences of the left electrode position in the lateral and vertical planes was significantly different between the two methods (0.30 and 0.24mm, respectively, both P<0.05), but there were no significant differences for the other electrode and planes (all P>0.05). The position of the electrodes was highly correlated between the fusion and postoperative MRI. The CT-MRI fusion images could be used to avoid the potential risks of MRI after DBS in patients with PD.
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Affiliation(s)
- Jun Xia
- Department of Radiology, Shenzhen Second People's Hospital (the First Affiliated Hospital of Shenzhen University), Shenzhen 518035, China
| | - Pin He
- Department of Radiology, Shenzhen Second People's Hospital (the First Affiliated Hospital of Shenzhen University), Shenzhen 518035, China
| | - Xiaodong Cai
- Department of Neurosurgery, Shenzhen Second People's Hospital (the First Affiliated Hospital of Shenzhen University), Shenzhen 518035, China
| | - Doudou Zhang
- Department of Neurosurgery, Shenzhen Second People's Hospital (the First Affiliated Hospital of Shenzhen University), Shenzhen 518035, China
| | - Ni Xie
- Central Laboratory, Shenzhen Second People's Hospital (the First Affiliated Hospital of Shenzhen University), Shenzhen 518035, China.
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Ko AL, Ibrahim A, Magown P, Macallum R, Burchiel KJ. Factors Affecting Stereotactic Accuracy in Image-Guided Deep Brain Stimulator Electrode Placement. Stereotact Funct Neurosurg 2017; 95:315-324. [DOI: 10.1159/000479527] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 07/11/2017] [Indexed: 11/19/2022]
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25
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van der Loo LE, Schijns OEMG, Hoogland G, Colon AJ, Wagner GL, Dings JTA, Kubben PL. Methodology, outcome, safety and in vivo accuracy in traditional frame-based stereoelectroencephalography. Acta Neurochir (Wien) 2017; 159:1733-1746. [PMID: 28676892 PMCID: PMC5557874 DOI: 10.1007/s00701-017-3242-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 05/31/2017] [Indexed: 11/24/2022]
Abstract
Background Stereoelectroencephalography (SEEG) is an established diagnostic technique for the localization of the epileptogenic zone in drug-resistant epilepsy. In vivo accuracy of SEEG electrode positioning is of paramount importance since higher accuracy may lead to more precise resective surgery, better seizure outcome and reduction of complications. Objective To describe experiences with the SEEG technique in our comprehensive epilepsy center, to illustrate surgical methodology, to evaluate in vivo application accuracy and to consider the diagnostic yield of SEEG implantations. Methods All patients who underwent SEEG implantations between September 2008 and April 2016 were analyzed. Planned electrode trajectories were compared with post-implantation trajectories after fusion of pre- and postoperative imaging. Quantitative analysis of deviation using Euclidean distance and directional errors was performed. Explanatory variables for electrode accuracy were analyzed using linear regression modeling. The surgical methodology, procedure-related complications and diagnostic yield were reported. Results Seventy-six implantations were performed in 71 patients, and a total of 902 electrodes were implanted. Median entry and target point deviations were 1.54 mm and 2.93 mm. Several factors that predicted entry and target point accuracy were identified. The rate of major complications was 2.6%. SEEG led to surgical therapy of various modalities in 53 patients (69.7%). Conclusions This study demonstrated that entry and target point localization errors can be predicted by linear regression models, which can aid in identification of high-risk electrode trajectories and further enhancement of accuracy. SEEG is a reliable technique, as demonstrated by the high accuracy of conventional frame-based implantation methodology and the good diagnostic yield.
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Gilmore G, Lee DH, Parrent A, Jog M. The current state of postoperative imaging in the presence of deep brain stimulation electrodes. Mov Disord 2017; 32:833-838. [DOI: 10.1002/mds.27028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 03/01/2017] [Accepted: 03/31/2017] [Indexed: 11/08/2022] Open
Affiliation(s)
- Greydon Gilmore
- Department of Biomedical Engineering; Western University; London Canada
- Department of Clinical Neurological Sciences; University Hospital; London Canada
| | - Donald H. Lee
- Department of Medical Imaging; University Hospital; London Canada
| | - Andrew Parrent
- Department of Clinical Neurological Sciences; University Hospital; London Canada
- Department of Neurosurgery; University Hospital; London Canada
| | - Mandar Jog
- Department of Biomedical Engineering; Western University; London Canada
- Department of Clinical Neurological Sciences; University Hospital; London Canada
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Metal Artifact Reduction in Computed Tomography After Deep Brain Stimulation Electrode Placement Using Iterative Reconstructions. Invest Radiol 2017; 52:18-22. [PMID: 27309775 DOI: 10.1097/rli.0000000000000296] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Diagnostic accuracy of intraoperative computed tomography (CT) after deep brain stimulation (DBS) electrode placement is limited due to artifacts induced by the metallic hardware, which can potentially mask intracranial postoperative complications. Different metal artifact reduction (MAR) techniques have been introduced to reduce artifacts from metal hardware in CT. The purpose of this study was to assess the impact of a novel iterative MAR technique on image quality and diagnostic performance in the follow-up of patients with DBS electrode implementation surgery. MATERIALS AND METHODS Seventeen patients who had received routine intraoperative CT of the head after implantation of DBS electrodes between March 2015 and June 2015 were retrospectively included. Raw data of all patients were reconstructed with standard weighted filtered back projection (WFBP) and additionally with a novel iterative MAR algorithm. We quantified frequencies of density changes to assess quantitative artifact reduction. For evaluation of qualitative image quality, the visibility of numerous cerebral anatomic landmarks and the detectability of intracranial electrodes were scored according to a 4-point scale. Furthermore, artifact strength overall and adjacent to the electrodes was rated. RESULTS Our results of quantitative artifact reduction showed that images reconstructed with iterative MAR (iMAR) contained significantly lower metal artifacts (overall low frequency values, 1608.6 ± 545.5; range, 375.5-3417.2) compared with the WFBP (overall low frequency values, 4487.3 ± 875.4; range, 2218.3-5783.5) reconstructed images (P < 0.004). Qualitative image analysis showed a significantly improved image quality for iMAR (overall anatomical landmarks, 2.49 ± 0.15; median, 3; range, 0-3; overall electrode characteristics, 2.35 ± 0.16; median, 2; range, 0-3; artifact characteristics, 2.16 ± 0.08; median, 2.5; range, 0-3) compared with WFBP (overall anatomical landmarks, 1.21 ± 0.64; median, 1; range, 0-3; overall electrode characteristics, 0.74 ± 0.37; median, 1; range, 0-2; artifact characteristics, 0.51 ± 0.15; median, 0.5; range, 0-2; P < 0.002). CONCLUSIONS Reconstructions of cranial CT images with the novel iMAR algorithm in patients after DBS implantation allows an efficient reduction of metal artifacts near DBS electrodes compared with WFBP reconstructions. We demonstrated an improvement of quantitative and qualitative image quality of iMAR compared with WFBP in patients with DBS electrodes.
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Lau JC, Khan AR, Zeng TY, MacDougall KW, Parrent AG, Peters TM. Quantification of local geometric distortion in structural magnetic resonance images: Application to ultra-high fields. Neuroimage 2017; 168:141-151. [PMID: 28069539 DOI: 10.1016/j.neuroimage.2016.12.066] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 12/20/2016] [Accepted: 12/22/2016] [Indexed: 12/13/2022] Open
Abstract
Ultra-high field magnetic resonance imaging (MRI) provides superior visualization of brain structures compared to lower fields, but images may be prone to severe geometric inhomogeneity. We propose to quantify local geometric distortion at ultra-high fields in in vivo datasets of human subjects scanned at both ultra-high field and lower fields. By using the displacement field derived from nonlinear image registration between images of the same subject, focal areas of spatial uncertainty are quantified. Through group and subject-specific analysis, we were able to identify regions systematically affected by geometric distortion at air-tissue interfaces prone to magnetic susceptibility, where the gradient coil non-linearity occurs in the occipital and suboccipital regions, as well as with distance from image isocenter. The derived displacement maps, quantified in millimeters, can be used to prospectively evaluate subject-specific local spatial uncertainty that should be taken into account in neuroimaging studies, and also for clinical applications like stereotactic neurosurgery where accuracy is critical. Validation with manual fiducial displacement demonstrated excellent correlation and agreement. Our results point to the need for site-specific calibration of geometric inhomogeneity. Our methodology provides a framework to permit prospective evaluation of the effect of MRI sequences, distortion correction techniques, and scanner hardware/software upgrades on geometric distortion.
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Affiliation(s)
- Jonathan C Lau
- Imaging Research Laboratories, Robarts Research Institute, London, Ontario, Canada; Biomedical Engineering Graduate Program, Western University, London, Ontario, Canada; Department of Clinical Neurological Sciences, Western University and London Health Sciences Centre, London, Ontario, Canada.
| | - Ali R Khan
- Imaging Research Laboratories, Robarts Research Institute, London, Ontario, Canada; Biomedical Engineering Graduate Program, Western University, London, Ontario, Canada; Department of Medical Biophysics, Western University, London, Ontario, Canada
| | - Tony Y Zeng
- Imaging Research Laboratories, Robarts Research Institute, London, Ontario, Canada
| | - Keith W MacDougall
- Department of Clinical Neurological Sciences, Western University and London Health Sciences Centre, London, Ontario, Canada
| | - Andrew G Parrent
- Department of Clinical Neurological Sciences, Western University and London Health Sciences Centre, London, Ontario, Canada
| | - Terry M Peters
- Imaging Research Laboratories, Robarts Research Institute, London, Ontario, Canada; Biomedical Engineering Graduate Program, Western University, London, Ontario, Canada; Department of Medical Biophysics, Western University, London, Ontario, Canada
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Golestanirad L, Angelone LM, Iacono MI, Katnani H, Wald LL, Bonmassar G. Local SAR near deep brain stimulation (DBS) electrodes at 64 and 127 MHz: A simulation study of the effect of extracranial loops. Magn Reson Med 2016; 78:1558-1565. [PMID: 27797157 DOI: 10.1002/mrm.26535] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 09/12/2016] [Accepted: 10/10/2016] [Indexed: 02/06/2023]
Abstract
PURPOSE MRI may cause brain tissue around deep brain stimulation (DBS) electrodes to become excessively hot, causing lesions. The presence of extracranial loops in the DBS lead trajectory has been shown to affect the specific absorption rate (SAR) of the radiofrequency energy at the electrode tip, but experimental studies have reported controversial results. The goal of this study was to perform a systematic numerical study to provide a better understanding of the effects of extracranial loops in DBS leads on the local SAR during MRI at 64 and 127 MHz. METHODS A total of 160 numerical simulations were performed on patient-derived data, in which relevant factors including lead length and trajectory, loop location and topology, and frequency of MRI radiofrequency (RF) transmitter were assessed. RESULTS Overall, the presence of extracranial loops reduced the local SAR in the tissue around the DBS tip compared with straight trajectories with the same length. SAR reduction was significantly larger at 127 MHz compared with 64 MHz. SAR reduction was significantly more sensitive to variable loop parameters (eg, topology and location) at 127 MHz compared with 64 MHz. CONCLUSION Lead management strategies could exist that significantly reduce the risks of 3 Tesla (T) MRI for DBS patients. Magn Reson Med 78:1558-1565, 2017. © 2016 International Society for Magnetic Resonance in Medicine.
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Affiliation(s)
- Laleh Golestanirad
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Leonardo M Angelone
- Division of Biomedical Physics, Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Maria Ida Iacono
- Division of Biomedical Physics, Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Husam Katnani
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Lawrence L Wald
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Giorgio Bonmassar
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
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Li Z, Zhang JG, Ye Y, Li X. Review on Factors Affecting Targeting Accuracy of Deep Brain Stimulation Electrode Implantation between 2001 and 2015. Stereotact Funct Neurosurg 2016; 94:351-362. [PMID: 27784015 DOI: 10.1159/000449206] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 08/16/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Accurate implantation of a depth electrode into the brain is of the greatest importance in deep brain stimulation (DBS), and various stereotactic systems have been developed for electrode implantation. However, an updated analysis of depth electrode implantation in the modern era of DBS is lacking. OBJECTIVE This study aims at providing an updated review on targeting accuracy of DBS electrode implantation by analyzing contemporary DBS electrode implantation operations from the perspective of precision engineering. METHODS Eligible articles with information on targeting accuracy of DBS electrode implantation were searched in the PubMed database. RESULTS An average targeting error of DBS electrode implantation is reported to decrease toward 1 mm; the standard deviation of targeting error is decreasing toward 0.5 mm. Targeting accuracy is not only found to be affected by individual surgical steps, but also systematically affected by the architecture of the implantation operation. CONCLUSION A systematic strategy should be adopted to further improve the targeting accuracy of depth electrode implantation. Attention should be paid to optimizing the whole electrode implantation operation, which can help minimize error accumulation or amplification throughout the serially connected procedures for DBS electrode implantation.
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Affiliation(s)
- Zhe Li
- Department of Biomedical Engineering, National University of Singapore, Singapore, Singapore
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Sammartino F, Krishna V, King NKK, Bruno V, Kalia S, Hodaie M, Marras C, Lozano AM, Fasano A. Sequence of electrode implantation and outcome of deep brain stimulation for Parkinson's disease. J Neurol Neurosurg Psychiatry 2016; 87:859-63. [PMID: 26354942 DOI: 10.1136/jnnp-2015-311426] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 08/17/2015] [Indexed: 11/03/2022]
Abstract
INTRODUCTION The effect of the variability of electrode placement on outcomes after bilateral deep brain stimulation of subthalamic nucleus has not been sufficiently studied, especially with respect to the sequence of hemisphere implantation. METHODOLOGY We retrospectively analysed the clinical and radiographic data of all the consecutive patients with Parkinson's disease who underwent surgery at our centre and completed at least 1 year follow-up. The dispersion in electrode location was calculated by the square of deviation from population mean, and the direction of deviation was analysed by comparing the intended and final implantation coordinates. Linear regression analysis was performed to analyse the predictors of postoperative improvement of the motor condition, also controlling for the sequence of implanted hemisphere. RESULTS 76 patients (mean age 58±7.2 years) were studied. Compared with the first side, the second side electrode tip had significantly higher dispersion as an overall effect (5.6±21.6 vs 2.2±4.9 mm(2), p=0.04), or along the X-axis (4.1±15.6 vs 1.4±2.4 mm(2), p=0.03) and Z-axis (4.9±11.5 vs 2.9±3.6 mm(2), p=0.02); the second side stimulation was also associated with a lower threshold for side effects (contact 0, p<0.001 and contact 3, p=0.004). In the linear regression analysis, the significant predictors of outcome were baseline activities of daily living (p=0.010) and dispersion of electrode on the second side (p=0.005). CONCLUSIONS We observed a higher dispersion for the electrode on the second implanted side, which also resulted to be a significant predictor of motor outcome at 1 year.
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Affiliation(s)
- Francesco Sammartino
- Division of Neurosurgery, University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Vibhor Krishna
- Division of Neurosurgery, University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Nicolas Kon Kam King
- Division of Neurosurgery, University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Veronica Bruno
- Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital - UHN, Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Suneil Kalia
- Division of Neurosurgery, University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Mojgan Hodaie
- Division of Neurosurgery, University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Connie Marras
- Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital - UHN, Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Andres M Lozano
- Division of Neurosurgery, University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Alfonso Fasano
- Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital - UHN, Division of Neurology, University of Toronto, Toronto, Ontario, Canada
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Ughratdar I, Samuel M, Ashkan K. Technological Advances in Deep Brain Stimulation. JOURNAL OF PARKINSONS DISEASE 2016; 5:483-96. [PMID: 26406128 DOI: 10.3233/jpd-150579] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Functional and stereotactic neurosurgery has always been regarded as a subspecialty based on and driven by technological advances. However until recently, the fundamentals of deep brain stimulation (DBS) hardware and software design had largely remained stagnant since its inception almost three decades ago. Recent improved understanding of disease processes in movement disorders as well clinician and patient demands has resulted in new avenues of development for DBS technology. This review describes new advances both related to hardware and software for neuromodulation. New electrode designs with segmented contacts now enable sophisticated shaping and sculpting of the field of stimulation, potentially allowing multi-target stimulation and avoidance of side effects. To avoid lengthy programming sessions utilising multiple lead contacts, new user-friendly software allows for computational modelling and individualised directed programming. Therapy delivery is being improved with the next generation of smaller profile, longer-lasting, re-chargeable implantable pulse generators (IPGs). These include IPGs capable of delivering constant current stimulation or personalised closed-loop adaptive stimulation. Post-implantation Magnetic Resonance Imaging (MRI) has long been an issue which has been partially overcome with 'MRI conditional devices' and has enabled verification of DBS lead location. Surgical technique is considering a shift from frame-based to frameless stereotaxy or greater role for robot assisted implantation. The challenge for these contemporary techniques however, will be in demonstrating equivalent safety and accuracy to conventional methods. We also discuss potential future direction utilising wireless technology allowing for miniaturisation of hardware.
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Carlson JD, McLeod KE, McLeod PS, Mark JB. Stereotactic Accuracy and Surgical Utility of the O-Arm in Deep Brain Stimulation Surgery. Oper Neurosurg (Hagerstown) 2016; 13:96-107. [DOI: 10.1227/neu.0000000000001326] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Accepted: 04/17/2016] [Indexed: 12/26/2022] Open
Abstract
Abstract
BACKGROUND: The stereotactic accuracy of intraoperative imaging is critical to clinical outcome, particularly in “asleep” deep brain stimulation (DBS) surgery that typically forgoes neurophysiological techniques. Different intraoperative imaging modalities and associated accuracies have been reported, including magnetic resonance imaging (MRI), computed tomography (CT), and O-arm.
OBJECTIVE: To analyze intraoperative O-arm imaging accuracy and to evaluate the utility of microelectrode mapping.
METHODS: O-arm images of DBS electrodes were collected during implantation in the subthalamic nucleus in patients with Parkinson disease. Images were fused to postoperative MRI and postoperative CT scans. Stereotactic coordinates for the electrode tip were measured independently. Radial distances between the images were compared. The impact of microelectrode mapping on final DBS electrode positioning was also evaluated.
RESULTS: In 71 consecutive DBS electrodes, the average radial error of the electrode tip between the O-arm and MRI was 1.55 ± 0.58 mm. The average radial error between the O-arm and CT was 1.03 ± 0.61 mm. Thus, the O-arm images accurately depicted the position of the electrode. However, in 14% of cases, microelectrode mapping revised the DBS electrode position beyond the preoperative direct target in combination with accurate intraoperative imaging.
CONCLUSION: Intraoperative O-arm images reliably and accurately displayed the location of the DBS electrode compared with postoperative CT and MRI images. Microelectrode mapping provided superior subnuclear resolution to imaging. Both intraoperative imaging and microelectrode mapping are effective tools that can be synergistically combined for optimal DBS electrode placement.
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Geevarghese R, O''Gorman Tuura R, Lumsden DE, Samuel M, Ashkan K. Registration Accuracy of CT/MRI Fusion for Localisation of Deep Brain Stimulation Electrode Position: An Imaging Study and Systematic Review. Stereotact Funct Neurosurg 2016; 94:159-63. [DOI: 10.1159/000446609] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 05/04/2016] [Indexed: 11/19/2022]
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Hlubek RJ, Theodore N, Chang SW. CT/MRI Fusion for Vascular Mapping and Navigated Resection of a Paraspinal Tumor. World Neurosurg 2016; 89:732.e7-732.e12. [PMID: 26893041 DOI: 10.1016/j.wneu.2016.01.091] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 01/20/2016] [Accepted: 01/22/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Computed tomography/magnetic resonance imaging (CT/MRI) fusion is used increasingly in the surgical treatment of cranial pathology. The merging of these complementary modalities provides excellent visualization of the bony anatomy and clear delineation of the soft tissues, including neurovascular structures. To our knowledge, the application of CT/MRI fusion for the surgical management of spinal pathology has not been reported previously. CASE DESCRIPTION A 70-year-old woman presented with a paraspinal tumor that originated from the right psoas muscle and extended into the lumbar neuroforamina, with intricate involvement of the lumbar plexus and retroperitoneal vasculature. CT/MRI fusion was used to map out the vessels surrounding the tumor and for intraoperative navigation during resection of this invasive paraspinal tumor. CONCLUSIONS This case highlights both the feasibility and the advantages of applying CT/MRI fusion technology to the surgical treatment of spinal pathology.
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Affiliation(s)
- Randall J Hlubek
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Nicholas Theodore
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Steve W Chang
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
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Chandran AS, Bynevelt M, Lind CRP. Magnetic resonance imaging of the subthalamic nucleus for deep brain stimulation. J Neurosurg 2016; 124:96-105. [DOI: 10.3171/2015.1.jns142066] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The subthalamic nucleus (STN) is one of the most important stereotactic targets in neurosurgery, and its accurate imaging is crucial. With improving MRI sequences there is impetus for direct targeting of the STN. High-quality, distortion-free images are paramount. Image reconstruction techniques appear to show the greatest promise in balancing the issue of geometrical distortion and STN edge detection. Existing spin echo- and susceptibility-based MRI sequences are compared with new image reconstruction methods. Quantitative susceptibility mapping is the most promising technique for stereotactic imaging of the STN.
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Affiliation(s)
| | - Michael Bynevelt
- 2Radiology, Sir Charles Gairdner Hospital, and
- 3School of Surgery, University of Western Australia, Perth, Western Australia, Australia
| | - Christopher R. P. Lind
- Departments of 1Neurosurgery and
- 3School of Surgery, University of Western Australia, Perth, Western Australia, Australia
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Jalali A, Srinivasan VM, Chinnadurai P, Kan P, Arthur A, Duckworth EAM. Two-color 3D-3D fusion of selective rotational cerebral angiograms: a novel approach to imaging in cerebrovascular neurosurgery. J Neurointerv Surg 2015; 8:1056-60. [PMID: 26574481 DOI: 10.1136/neurintsurg-2015-011963] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 09/25/2015] [Indexed: 11/04/2022]
Abstract
BACKGROUND Since its introduction, digital subtraction angiography has been considered the gold standard in diagnostic imaging for neurovascular disease. Modern post-processing techniques have made angiography even more informative to the cerebrovascular neurosurgeon or neurointerventionalist. Open neurosurgical procedures such as aneurysm clipping, extirpation of arteriovenous malformations, and extracranial-intracranial bypass remain important techniques in the armamentarium of a comprehensive cerebrovascular neurosurgeon. In-depth study of the anatomy of vascular pathology prior to and after surgery, often via selective cerebral angiography, is a critical component of surgical planning. However, when a vascular lesion or relevant anatomical region is perfused by two or more vascular territories, each selective angiographic imaging volume may provide an incomplete anatomical picture. METHODS An institutional database was searched for cases in which the syngo Inspace 3D-3D fusion software was used and assisted in diagnosis and surgical management. RESULTS In the six cases reviewed, the 3D-3D fusion imaging was crucial in understanding the anatomy of the vascular lesion and aided in surgical decision-making. The cases included two unique anterior communicating artery aneurysms, an arteriovenous malformation, an extracranial-intracranial bypass, and an angiographically negative subarachnoid hemorrhage. CONCLUSIONS This is a novel strategy of combining two independently acquired selective cerebral angiography volumes to create a more accurate representation of the vascular anatomy. Given the increasing availability of the relevant image acquisition and processing technologies, we propose this strategy as a valuable adjunct in cerebrovascular procedures.
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Affiliation(s)
- Ali Jalali
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | | | | | - Peter Kan
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Adam Arthur
- Department of Neurosurgery, Semmes-Murphey Neurologic and Spine Institute, and University of Tennessee College of Medicine, Memphis, Tennessee, USA
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Bot M, van den Munckhof P, Bakay R, Sierens D, Stebbins G, Verhagen Metman L. Analysis of Stereotactic Accuracy in Patients Undergoing Deep Brain Stimulation Using Nexframe and the Leksell Frame. Stereotact Funct Neurosurg 2015; 93:316-25. [DOI: 10.1159/000375178] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 01/13/2015] [Indexed: 11/19/2022]
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Satzer D, Maurer EW, Lanctin D, Guan W, Abosch A. Anatomic correlates of deep brain stimulation electrode impedance. J Neurol Neurosurg Psychiatry 2015; 86:398-403. [PMID: 24935985 DOI: 10.1136/jnnp-2013-307284] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND The location of the optimal target for deep brain stimulation (DBS) of the subthalamic nucleus (STN) remains controversial. Electrode impedance affects tissue activation by DBS and has been found to vary by contact number, but no studies have examined association between impedance and anatomic location. OBJECTIVES To evaluate the relationship between electrode impedance and anatomic contact location, and to assess the clinical significance of impedance. METHODS We gathered retrospective impedance data from 101 electrodes in 73 patients with Parkinson's disease. We determined contact location using microelectrode recording (MER) and high-field 7T MRI, and assessed the relationship between impedance and contact location. RESULTS For contact location as assessed via MER, impedance was significantly higher for contacts in STN, at baseline (111 Ω vs STN border, p=0.03; 169 Ω vs white matter, p<0.001) and over time (90 Ω vs STN border, p<0.001; 54 Ω vs white matter, p<0.001). Over time, impedance was lowest in contacts situated at STN border (p=0.03). Impedance did not vary by contact location as assessed via imaging. Location determination was 75% consistent between MER and imaging. Impedance was inversely related to absolute symptom reduction during stimulation (-2.5 motor portion of the Unified Parkinson's Disease Rating Scale (mUPDRS) points per 1000 Ω, p=0.01). CONCLUSIONS In the vicinity of DBS electrodes chronically implanted in STN, impedance is lower at the rostral STN border and in white matter, than in STN. This finding suggests that current reaches white matter fibres more readily than neuronal cell bodies in STN, which may help explain anatomic variation in stimulation efficacy.
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Affiliation(s)
- David Satzer
- Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Eric W Maurer
- Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - David Lanctin
- Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Weihua Guan
- Department of Biostatistics, University of Minnesota, Minneapolis, Minnesota, USA
| | - Aviva Abosch
- Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota, USA Department of Neurosurgery, University of Colorado, Denver, Colorado, USA
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Starr PA, Markun LC, Larson PS, Volz MM, Martin AJ, Ostrem JL. Interventional MRI-guided deep brain stimulation in pediatric dystonia: first experience with the ClearPoint system. J Neurosurg Pediatr 2014; 14:400-8. [PMID: 25084088 DOI: 10.3171/2014.6.peds13605] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The placement of deep brain stimulation (DBS) leads in adults is traditionally performed using physiological confirmation of lead location in the awake patient. Most children are unable to tolerate awake surgery, which poses a challenge for intraoperative confirmation of lead location. The authors have developed an interventional MRI (iMRI)-guided procedure to allow for real-time anatomical imaging, with the goal of achieving very accurate lead placement in patients who are under general anesthesia. METHODS Six pediatric patients with primary dystonia were prospectively enrolled. Patients were candidates for surgery if they had marked disability and medical therapy had been ineffective. Five patients had the DYT1 mutation, and mean age at surgery was 11.0 ± 2.8 years. Patients underwent bilateral globus pallidus internus (GPi, n = 5) or sub-thalamic nucleus (STN, n = 1) DBS. The leads were implanted using a novel skull-mounted aiming device in conjunction with dedicated software (ClearPoint system), used within a 1.5-T diagnostic MRI unit in a radiology suite, without physiological testing. The Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) was used at baseline, 6 months, and 12 months postoperatively. Further measures included lead placement accuracy, quality of life, adverse events, and stimulation settings. RESULTS A single brain penetration was used for placement of all 12 leads. The mean difference (± SD) between the intended target location and the actual lead location, in the axial plane passing through the intended target, was 0.6 ± 0.5 mm, and the mean surgical time (leads only) was 190 ± 26 minutes. The mean percent improvement in the BFMDRS movement scores was 86.1% ± 12.5% at 6 months (n = 6, p = 0.028) and 87.6% ± 19.2% at 12 months (p = 0.028). The mean stimulation settings at 12 months were 3.0 V, 83 μsec, 135 Hz for GPi DBS, and 2.1 V, 60 μsec, 145 Hz for STN DBS). There were no serious adverse events. CONCLUSIONS Interventional MRI-guided DBS using the ClearPoint system was extremely accurate, provided real-time confirmation of DBS placement, and could be used in any diagnostic MRI suite. Clinical outcomes for pediatric dystonia are comparable with the best reported results using traditional frame-based stereotaxy. Clinical trial registration no.: NCT00792532 ( ClinicalTrials.gov ).
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Adams A, Shand-Smith J, Watkins L, McEvoy AW, Elneil S, Zrinzo L, Davagnanam I. Neural stimulators: a guide to imaging and postoperative appearances. Clin Radiol 2014; 69:993-1003. [PMID: 24842398 DOI: 10.1016/j.crad.2014.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Revised: 03/02/2014] [Accepted: 03/05/2014] [Indexed: 11/28/2022]
Abstract
Implantable neural stimulators have been developed to aid patients with debilitating neurological conditions that are not amenable to other therapies. The aim of this article is to improve understanding of correct anatomical placement as well as the relevant imaging methods used to assess these devices. Potential complications following their insertion and an overview of the current indications and potential mechanism of action of these devices is provided.
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Affiliation(s)
- A Adams
- Department of Neuroradiology, Barts and the Royal London Hospital, West Smithfield, London, EC1A 7BE, UK.
| | - J Shand-Smith
- Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, London, UK
| | - L Watkins
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - A W McEvoy
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - S Elneil
- Department of Urogynaecology, National Hospital for Neurology and Neurosurgery, London, UK
| | - L Zrinzo
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - I Davagnanam
- Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, London, UK
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Nestor KA, Jones JD, Butson CR, Morishita T, Jacobson CE, Peace DA, Chen D, Foote KD, Okun MS. Coordinate-based lead location does not predict Parkinson's disease deep brain stimulation outcome. PLoS One 2014; 9:e93524. [PMID: 24691109 PMCID: PMC3972103 DOI: 10.1371/journal.pone.0093524] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Accepted: 03/06/2014] [Indexed: 12/02/2022] Open
Abstract
Background Effective target regions for deep brain stimulation (DBS) in Parkinson's disease (PD) have been well characterized. We sought to study whether the measured Cartesian coordinates of an implanted DBS lead are predictive of motor outcome(s). We tested the hypothesis that the position and trajectory of the DBS lead relative to the mid-commissural point (MCP) are significant predictors of clinical outcomes. We expected that due to neuroanatomical variation among individuals, a simple measure of the position of the DBS lead relative to MCP (commonly used in clinical practice) may not be a reliable predictor of clinical outcomes when utilized alone. Methods 55 PD subjects implanted with subthalamic nucleus (STN) DBS and 41 subjects implanted with globus pallidus internus (GPi) DBS were included. Lead locations in AC-PC space (x, y, z coordinates of the active contact and sagittal and coronal entry angles) measured on high-resolution CT-MRI fused images, and motor outcomes (Unified Parkinson's Disease Rating Scale) were analyzed to confirm or refute a correlation between coordinate-based lead locations and DBS motor outcomes. Results Coordinate-based lead locations were not a significant predictor of change in UPDRS III motor scores when comparing pre- versus post-operative values. The only potentially significant individual predictor of change in UPDRS motor scores was the antero-posterior coordinate of the GPi lead (more anterior lead locations resulted in a worse outcome), but this was only a statistical trend (p<.082). Conclusion The results of the study showed that a simple measure of the position of the DBS lead relative to the MCP is not significantly correlated with PD motor outcomes, presumably because this method fails to account for individual neuroanatomical variability. However, there is broad agreement that motor outcomes depend strongly on lead location. The results suggest the need for more detailed identification of stimulation location relative to anatomical targets.
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Affiliation(s)
- Kelsey A. Nestor
- Department of Neurology, University of Florida, Center for Movement Disorders and Neurorestoration, McKnight Brain Institute, Gainesville, Florida, United States of America
- Department of Neurosurgery, University of Florida, Center for Movement Disorders and Neurorestoration, McKnight Brain Institute, Gainesville, Florida, United States of America
| | - Jacob D. Jones
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida, United States of America
| | - Christopher R. Butson
- Department of Neurology, Biotechnology and Bioengineering Center, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
| | - Takashi Morishita
- Department of Neurosurgery, University of Florida, Center for Movement Disorders and Neurorestoration, McKnight Brain Institute, Gainesville, Florida, United States of America
| | - Charles E. Jacobson
- Department of Neurology, University of Florida, Center for Movement Disorders and Neurorestoration, McKnight Brain Institute, Gainesville, Florida, United States of America
| | - David A. Peace
- Department of Neurosurgery, University of Florida, Center for Movement Disorders and Neurorestoration, McKnight Brain Institute, Gainesville, Florida, United States of America
| | - Dennis Chen
- Department of Neurology, University of Florida, Center for Movement Disorders and Neurorestoration, McKnight Brain Institute, Gainesville, Florida, United States of America
- Department of Neurosurgery, University of Florida, Center for Movement Disorders and Neurorestoration, McKnight Brain Institute, Gainesville, Florida, United States of America
| | - Kelly D. Foote
- Department of Neurosurgery, University of Florida, Center for Movement Disorders and Neurorestoration, McKnight Brain Institute, Gainesville, Florida, United States of America
| | - Michael S. Okun
- Department of Neurology, University of Florida, Center for Movement Disorders and Neurorestoration, McKnight Brain Institute, Gainesville, Florida, United States of America
- Department of Neurosurgery, University of Florida, Center for Movement Disorders and Neurorestoration, McKnight Brain Institute, Gainesville, Florida, United States of America
- * E-mail:
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Long S, Frey S, Freestone DR, LeChevoir M, Stypulkowski P, Giftakis J, Cook M. Placement of deep brain electrodes in the dog using the Brainsight frameless stereotactic system: a pilot feasibility study. J Vet Intern Med 2013; 28:189-97. [PMID: 24237394 PMCID: PMC4895539 DOI: 10.1111/jvim.12235] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Revised: 09/03/2013] [Accepted: 09/19/2013] [Indexed: 12/03/2022] Open
Abstract
Background Deep brain stimulation (DBS) together with concurrent EEG recording has shown promise in the treatment of epilepsy. A novel device is capable of combining these 2 functions and may prove valuable in the treatment of epilepsy in dogs. However, stereotactic implantation of electrodes in dogs has not yet been evaluated. Objective To evaluate the feasibility and safety of implanting stimulating and recording electrodes in the brain of normal dogs using the Brainsight system and to evaluate the function of a novel DBS and recording device. Animals Four male intact Greyhounds, confirmed to be normal by clinical and neurologic examinations and hematology and biochemistry testing. Methods MRI imaging of the brain was performed after attachment of fiducial markers. MRI scans were used to calculate trajectories for electrode placement in the thalamus and hippocampus, which was performed via burr hole craniotomy. Postoperative CT scanning was performed to evaluate electrode location and accuracy of placement was calculated. Serial neurologic examinations were performed to evaluate neurologic deficits and EEG recordings obtained to evaluate the effects of stimulation. Results Electrodes were successfully placed in 3 of 4 dogs with a mean accuracy of 4.6 ± 1.5 mm. EEG recordings showed evoked potentials in response to stimulation with a circadian variation in time‐to‐maximal amplitude. No neurologic deficits were seen in any dog. Conclusions and Clinical Importance Stereotactic placement of electrodes is safe and feasible in the dog. The development of a novel device capable of providing simultaneous neurostimulation and EEG recording potentially represents a major advance in the treatment of epilepsy.
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Affiliation(s)
- S Long
- Section of Neurology and Neurosurgery, Faculty of Veterinary Science, University of Melbourne, Melbourne, Australia
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Watson C, Lind CRP, Thomas MG. The anatomy of the caudal zona incerta in rodents and primates. J Anat 2013; 224:95-107. [PMID: 24138151 DOI: 10.1111/joa.12132] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2013] [Indexed: 11/29/2022] Open
Abstract
The caudal zona incerta is the target of a recent modification of established procedures for deep brain stimulation (DBS) for Parkinson's disease and tremor. The caudal zona incerta contains a number of neuronal populations that are distinct in terms of their cytoarchitecture, connections, and pattern of immunomarkers and is located at a position where a number of major tracts converge before turning toward their final destination in the forebrain. However, it is not clear which of the anatomical features of the region are related to its value as a target for DBS. This paper has tried to identify features that distinguish the caudal zona incerta of rodents (mouse and rat) and primates (marmoset, rhesus monkey, and human) from the remainder of the zona incerta. We studied cytoarchitecture, anatomical relationships, the pattern of immunomarkers, and gene expression in both of these areas. We found that the caudal zona incerta has a number of histological and gene expression characteristics that distinguish it from the other subdivisions of the zona incerta. Of particular note are the sparse population of GABA neurons and the small but distinctive population of calbindin neurons. We hope that a clearer appreciation of the anatomy of the region will in the end assist the interpretation of cases in which DBS is used in human patients.
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Affiliation(s)
- Charles Watson
- Curtin University, Perth, Australia; Neuroscience Research Australia, Sydney, Australia
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Patil PG, Conrad EC, Aldridge JW, Chenevert TL, Chou KL. The Anatomical and Electrophysiological Subthalamic Nucleus Visualized by 3-T Magnetic Resonance Imaging. Neurosurgery 2013; 71:1089-95; discussion 1095. [DOI: 10.1227/neu.0b013e318270611f] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
ABSTRACT
BACKGROUND:
Accurate localization of the subthalamic nucleus (STN) is critical to the success of deep brain stimulation surgery for Parkinson disease. Recent developments in high-field-strength magnetic resonance imaging (MRI) have made it possible to visualize the STN in greater detail. However, the relationship of the MR-visualized STN to the anatomic, electrophysiological, or atlas-predicted STN remains controversial.
OBJECTIVE:
To evaluate the size of the STN visualized on 3-T MRI compared with anatomic measurements in cadaver studies and to compare the predictions of 3-T MRI and those of the Schaltenbrand-Wahren (SW) atlas for intraoperative STN microelectrode recordings.
METHODS:
We evaluated the STN by 3-T MRI and intraoperative microelectrode recordings in 20 Parkinson disease patients undergoing deep brain stimulation surgery. We compared our findings with anatomic cadaver studies and with the individually scaled SW atlas-based predictions for each patient.
RESULTS:
The dimensions of the 3-T MR-visualized STN were very similar to those of the largest anatomic study (MRI length, width, and height: 9.8 ± 1.6, 11.5 ± 1.6, and 3.7 ± 0.7 mm, respectively; n = 40; cadaver length, width, and height: 9.3 ± 0.7, 10.6 ± 0.9, and 3.1 ± 0.5 mm, respectively; n = 100). The amount of STN traversed during intraoperative microelectrode recordings was better correlated to the 3-T MR-visualized STN than the SW atlas-predicted STN (R = 0.38 vs R = −0.17).
CONCLUSION:
The STN as visualized on 3-T MRI corresponds well with cadaveric anatomic studies and intraoperative electrophysiology. STN visualization with 3-T MRI may be an improvement over SW atlas-based localization for STN deep brain stimulation surgery in Parkinson disease.
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Affiliation(s)
- Parag G. Patil
- Surgical Therapies Improving Movement Program, University of Michigan Health System, Ann Arbor, Michigan
- Departments of Neurosurgery
- Departments of Neurology
- Departments of Biomedical Engineering
| | - Erin C. Conrad
- Surgical Therapies Improving Movement Program, University of Michigan Health System, Ann Arbor, Michigan
- Departments of Neurosurgery
| | - J. Wayne Aldridge
- Surgical Therapies Improving Movement Program, University of Michigan Health System, Ann Arbor, Michigan
- Departments of Neurosurgery
| | | | - Kelvin L. Chou
- Surgical Therapies Improving Movement Program, University of Michigan Health System, Ann Arbor, Michigan
- Departments of Neurosurgery
- Departments of Neurology
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Contarino MF, Bot M, Speelman JD, de Bie RMA, Tijssen MA, Denys D, Bour LJ, Schuurman PR, van den Munckhof P. Postoperative Displacement of Deep Brain Stimulation Electrodes Related to Lead-Anchoring Technique. Neurosurgery 2013; 73:681-8; discussion 188. [DOI: 10.1227/neu.0000000000000079] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Abstract
BACKGROUND:
Displacement of deep brain stimulation (DBS) electrodes may occur after surgery, especially due to large subdural air collections, but other factors might contribute.
OBJECTIVE:
To investigate factors potentially contributing to postoperative electrode displacement, in particular, different lead-anchoring techniques.
METHODS:
We retrospectively analyzed 55 patients (106 electrodes) with Parkinson disease, dystonia, tremor, and obsessive-compulsive disorder in whom early postoperative and long-term follow-up computed tomography (CT) was performed. Electrodes were anchored with a titanium microplate or with a commercially available plastic cap system. Two independent examiners determined the stereotactic coordinates of the deepest DBS contact on early postoperative and long-term follow-up CT. The influence of age, surgery duration, subdural air volume, use of microrecordings, fixation method, follow-up time, and side operated on first was assessed.
RESULTS:
Subdural air collections measured on average 4.3 ± 6.2 cm3. Three-dimensional (3-D) electrode displacement and displacement in the X, Y, and Z axes significantly correlated only with the anchoring method, with larger displacement for microplate-anchored electrodes. The average 3-D displacement for microplate-anchored electrodes was 2.3 ± 2.0 mm vs 1.5 ± 0.6 mm for electrodes anchored with the plastic cap (P = .030). Fifty percent of the microplate-anchored electrodes showed 2-mm or greater (potentially relevant) 3-D displacement vs only 25% of the plastic cap–anchored electrodes (P < .01).
CONCLUSION:
The commercially available plastic cap system is more efficient in preventing postoperative DBS electrode displacement than titanium microplates. A reliability analysis of the electrode fixation is warranted when alternative anchoring methods are used.
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Affiliation(s)
- M. Fiorella Contarino
- Departments of Neurology Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Maarten Bot
- Departments ofNeurosurgery; and Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Johannes D. Speelman
- Departments of Neurology Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Rob M. A. de Bie
- Departments of Neurology Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Marina A. Tijssen
- Departments of Neurology Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- Departments of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Damiaan Denys
- Department of Neurology, University Medical Centre Groningen, Groningen, the Netherlands
| | - Lo J. Bour
- Departments of Neurology Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - P. Richard Schuurman
- Departments ofNeurosurgery; and Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Pepijn van den Munckhof
- Departments ofNeurosurgery; and Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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van Rooijen BD, Backes WH, Schijns OE, Colon A, Hofman PA. Brain Imaging in Chronic Epilepsy Patients After Depth Electrode (Stereoelectroencephalography) Implantation. Neurosurgery 2013; 73:543-9. [DOI: 10.1227/01.neu.0000431478.79536.68] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND:
The accurate localization of depth electrodes in epilepsy surgery is important for correct interpretation of stereoelectroencephalography recordings and neurosurgical resection. Unfortunately, image quality in postimplantation magnetic resonance imaging (MRI) is degraded by metal artifacts. The registration of postimplantation computed tomography (CT) or MRI to preimplantation (artifact-free) MRI facilitates electrode imaging and optimal visualization of brain anatomy. However, registration errors negatively affect electrode localization accuracy.
OBJECTIVE:
To compare the relative registration deviation between postimplantation CT and MRI with preimplantation MRI.
METHODS:
Retrospectively, 14 pharmacoresistant epilepsy patients were included who underwent stereotactic insertion of multiple depth electrodes and preimplantation and postimplantation MRI and postimplantation CT. Postimplantation MRI and CT image sets were registered to preimplantation MRI. The registration error between the registered postimplantation MRI and CT was quantified by measuring the geometrical distance between the electrodes of the registered postimplantation CT and the postimplantation MRI.
RESULTS:
The registration error of postimplantation imaging to preimplantation MRI was dependent on the algorithm used. After optimization, the smallest registration error was 1.22 ± 0.29 mm (mean ± SD) at the tip and 2.25 ± 1.18 mm at the base of the electrode.
CONCLUSION:
The good correspondence between the CT/MRI and the MRI/MRI registration suggests that either postimplantation MRI or CT is sufficient for accurate electrode localization. In case of postoperative morphological brain deformations, postimplantation MRI is still recommended.
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Affiliation(s)
| | | | - Olaf E.M.G. Schijns
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Albert Colon
- Epilepsy Centre Kempenhaeghe, Heeze, the Netherlands
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Lumsden DE, Ashmore J, Charles-Edwards G, Lin JP, Ashkan K, Selway R. Accuracy of stimulating electrode placement in paediatric pallidal deep brain stimulation for primary and secondary dystonia. Acta Neurochir (Wien) 2013; 155:823-36. [PMID: 23430231 DOI: 10.1007/s00701-013-1629-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Accepted: 01/24/2013] [Indexed: 12/14/2022]
Abstract
BACKGROUND Accuracy of electrode placement is an important determinant of outcome following deep brain stimulation (DBS) surgery. Data on accuracy of electrode placement into the globus pallidum interna (GPi) in paediatric patients is limited, particularly those with non-primary dystonia who often have smaller GPi. Pallidal DBS is known to be more effective in the treatment of primary dystonia compared with secondary dystonia. OBJECTIVES We aimed to determine if accuracy of pallidal electrode placement differed between primary, secondary and NBIA (neuronal degeneration and brain iron accumulation) associated dystonia and how this related to motor outcome following surgery. METHODS A retrospective review of a consecutive cohort of children and young people undergoing DBS surgery in a single centre. Fused in frame preoperative planning magnetic resonance imaging (MRI) and postoperative computed tomography (CT) brain scans were used to determine the accuracy of placement of DBS electrode tip in Leskell stereotactic system compared with the planned target. The differences along X, Y, and Z coordinates were calculated, as was the Euclidean distance of electrode tip from the target. The relationship between proximity to target and change in Burke-Fahn-Marsden Dystonia Rating Scale at 1 year was also measured. RESULTS Data were collected from 88 electrodes placed in 42 patients (14 primary dystonia, 18 secondary dystonia and 10 NBIA associated dystonia). Median differences between planned target and actual position were: left-side X-axis 1.05 mm, Y-axis 0.85 mm, Z-axis 0.94 mm and Euclidean difference 2.04 mm; right-side X-axis 1.28 mm, Y-axis 0.70 mm, Z-axis 0.70 mm and Euclidean difference 2.45 mm. Accuracy did not differ between left and right-sided electrodes. No difference in accuracy was seen between primary, secondary or NBIA associated dystonia. Dystonia reduction at 1 year post surgery did not appear to relate to proximity of implanted electrode to surgical target across the cohort. CONCLUSIONS Accuracy of surgical placement did not differ between primary, secondary or NBIA associated dystonia. Decreased efficacy of pallidal DBS in secondary and NBIA associated dystonia is unlikely to be related to difficulties in achieving the planned electrode placement.
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Affiliation(s)
- Daniel E Lumsden
- Complex Motor Disorders Service, Evelina Children's Hospital, Guy's & St Thomas' NHS Foundation Trust, Lambeth Palace Road, London, SE1 7EH, UK.
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Abstract
INTRODUCTION "Navigation in surgery" spans a broad area, which, depending on the clinical challenge, can have different meanings. Over the past decade, navigation in surgery has evolved beyond imaging modalities and bulky systems into the rich networking of the cloud or devices that are pocket-sized. DISCUSSION This article will review various aspects of navigation in the operating room and beyond. This includes a short history of navigation, the evolution of surgical navigation, as well as technical aspects and clinical benefits with examples from neurosurgery, spinal surgery, and orthopedics. CONCLUSION With improved computer technology and a trend towards advanced information processing within hospitals, navigation is quickly becoming an integral part in the surgical routine of clinicians.
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Weise L, Eibach S, Seifert V, Setzer M. Intraoperative 3D fluoroscopy in stereotactic surgery. Acta Neurochir (Wien) 2012; 154:815-21. [PMID: 22350362 DOI: 10.1007/s00701-012-1288-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2011] [Accepted: 01/16/2012] [Indexed: 12/01/2022]
Abstract
BACKGROUND Intraoperative localisation of a stereotactic probe remains challenging. Stereotactic X-ray, the "gold standard", as well as intraoperative magnetic resonance (MRI) and computed tomography (CT), require a dedicated operating room (OR). Fluoroscopy with crosshairs confirms only grossly the target position. An alternative would be a mobile three-dimensional (3D) fluoroscopy C-arm. To our knowledge, this is the first report on 3D C-arm fluoroscopy to verify stereotactical trajectories. The objective was to assess the feasibility of using a 3D C-arm to verify the intraoperative trajectory and target. METHODS A total of 12 stereotactic trajectories in 10 patients were analysed, comprising 8 biopsies and 4 electrode trajectories. The fluoroscopic scan was performed after implantation of the deep brain stimulation electrode or after advancing the biopsy needle to the tumour. An image set is acquired during a rotation of the 3D C-arm. The image set is reconstructed and merged to the preoperative CT scan. Calculating the vector error and the deviation assesses target and trajectory accuracy. RESULTS The mean trajectory deviation was 0.6 mm (±0.54 mm) and the mean vector error was 1.44 mm (±1.43 mm). There was no influence on the surgical time and the mean irradiation dosage was 401.9 cGycm(2). CONCLUSIONS This target and trajectory verification is feasible. Its accuracy seems comparable with MRI and CT. There is no additional time consumption. Irradiation is comparable with stereotactic X-ray.
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Affiliation(s)
- Lutz Weise
- Klinik für Neurochirurgie, Goethe Universität Frankfurt am Main, Germany.
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