Intraoperative X-Ray Detection and MRI-Based Quantification of Brain Shift Effects Subsequent to Implantation of the First Electrode in Bilateral Implantation of Deep Brain Stimulation Electrodes
Objective: After implantation of the first electrode in bilateral deep brain stimulation (DBS) lead implantation, brain shift effects in the target region and along the implantation trajectory of the second electrode are quantified with intra-operative magnetic resonance imaging (MRI). We investigated intra-operative X-ray imaging for its feasibility in indirect detection of brain shift. Methods: In 25 patients who underwent bilateral DBS lead implantation, X-ray and MRI were performed before and after implantation of the first electrode. Two parameters of brain shift were assessed with nonrigid free-form deformation field analysis of the MRI data: global brain shift along the anterior and posterior commissure (AC-PC) line and specific brain shift along the implantation trajectory of the second electrode. Pre- and intraoperative X-ray images were geometrically and intensity corrected for detection of significant signal changes through intracranial air accumulation during implantation of the first electrode. Results: After implantation of the first electrode, brain shift greater than 1 mm (maximum 1.3 mm) was observed at the AC and brain shift greater than 2 mm (maximum 2.5 mm) was observed along the planned implantation trajectory of the second electrode. In 1 patient, the implantation trajectory of the second electrode went through a sulcus after cortical brain shift. In 9 patients, intracranial air volume between 0.1 and 38.5 ml was observed with MRI after implantation of the first electrode. Significant X-ray absorption changes were induced by an intracranial air volume of greater than 8 ml. Conclusion: In bilateral DBS implantation, brain shift effects can cause misallocation of the second electrode with the risk of adverse or no stimulation effects as well as unnecessary cortical damage. A lack of X-ray signal changes caused by intracranial air invasion during DBS lead implantation indicates a lack of clinically relevant brain shift. Copyright (C) 2009 S. Karger AG, Basel
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ASL Roma 2, CTO Hosp, Stereotact & Funct Unit, Via S Nemesio 21, I-00145 Rome, ItalyASL Roma 2, CTO Hosp, Stereotact & Funct Unit, Via S Nemesio 21, I-00145 Rome, Italy
Mazzone, Paolo
Stefani, Alessandro
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Univ Roma Tor Vergata, Dept Syst Med, UOSD Parkinson, I-00133 Rome, ItalyASL Roma 2, CTO Hosp, Stereotact & Funct Unit, Via S Nemesio 21, I-00145 Rome, Italy
Stefani, Alessandro
Viselli, Fabio
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ACISMOM, St John Baptist Hosp, UO Neurol, I-00148 Rome, ItalyASL Roma 2, CTO Hosp, Stereotact & Funct Unit, Via S Nemesio 21, I-00145 Rome, Italy
Viselli, Fabio
Scarnati, Eugenio
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Univ Aquila, Dept Biotechnol & Appl Clin Sci, I-67100 Laquila, ItalyASL Roma 2, CTO Hosp, Stereotact & Funct Unit, Via S Nemesio 21, I-00145 Rome, Italy
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Univ Sao Paulo, Ribeirao Preto Med Sch, Ribeirao Preto, SP, BrazilUniv Sao Paulo, Ribeirao Preto Med Sch, Ribeirao Preto, SP, Brazil
Matias, Caio M.
Frizon, Leonardo A.
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Cleveland Clin, Ctr Neurol Restorat, Neurol Inst, 9500 Euclid Ave, Cleveland, OH 44195 USAUniv Sao Paulo, Ribeirao Preto Med Sch, Ribeirao Preto, SP, Brazil
Frizon, Leonardo A.
Asfahan, Fadi
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Cleveland Clin, Ctr Neurol Restorat, Neurol Inst, 9500 Euclid Ave, Cleveland, OH 44195 USAUniv Sao Paulo, Ribeirao Preto Med Sch, Ribeirao Preto, SP, Brazil
Asfahan, Fadi
Uribe, Juan D.
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Cleveland Clin, Ctr Neurol Restorat, Neurol Inst, 9500 Euclid Ave, Cleveland, OH 44195 USAUniv Sao Paulo, Ribeirao Preto Med Sch, Ribeirao Preto, SP, Brazil
Uribe, Juan D.
Machado, Andre G.
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Cleveland Clin, Ctr Neurol Restorat, Neurol Inst, 9500 Euclid Ave, Cleveland, OH 44195 USAUniv Sao Paulo, Ribeirao Preto Med Sch, Ribeirao Preto, SP, Brazil
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Nihon Univ, Sch Med, Dept Neurol Surg, Tokyo 1738610, JapanNihon Univ, Sch Med, Div Appl Syst Neurosci, Dept Adv Med Sci,Itabashi Ku, Tokyo 1738610, Japan
Obuchi, Toshiki
Katayama, Yoichi
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Nihon Univ, Sch Med, Div Appl Syst Neurosci, Dept Adv Med Sci,Itabashi Ku, Tokyo 1738610, Japan
Nihon Univ, Sch Med, Dept Neurol Surg, Tokyo 1738610, JapanNihon Univ, Sch Med, Div Appl Syst Neurosci, Dept Adv Med Sci,Itabashi Ku, Tokyo 1738610, Japan
Katayama, Yoichi
Kobayashi, Kazutaka
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Nihon Univ, Sch Med, Div Appl Syst Neurosci, Dept Adv Med Sci,Itabashi Ku, Tokyo 1738610, Japan
Nihon Univ, Sch Med, Dept Neurol Surg, Tokyo 1738610, JapanNihon Univ, Sch Med, Div Appl Syst Neurosci, Dept Adv Med Sci,Itabashi Ku, Tokyo 1738610, Japan
Kobayashi, Kazutaka
Oshima, Hideki
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Nihon Univ, Sch Med, Dept Neurol Surg, Tokyo 1738610, JapanNihon Univ, Sch Med, Div Appl Syst Neurosci, Dept Adv Med Sci,Itabashi Ku, Tokyo 1738610, Japan
Oshima, Hideki
Fukaya, Chikashi
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Nihon Univ, Sch Med, Div Appl Syst Neurosci, Dept Adv Med Sci,Itabashi Ku, Tokyo 1738610, Japan
Nihon Univ, Sch Med, Dept Neurol Surg, Tokyo 1738610, JapanNihon Univ, Sch Med, Div Appl Syst Neurosci, Dept Adv Med Sci,Itabashi Ku, Tokyo 1738610, Japan
Fukaya, Chikashi
Yamamoto, Takamitsu
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Nihon Univ, Sch Med, Div Appl Syst Neurosci, Dept Adv Med Sci,Itabashi Ku, Tokyo 1738610, Japan
Nihon Univ, Sch Med, Dept Neurol Surg, Tokyo 1738610, JapanNihon Univ, Sch Med, Div Appl Syst Neurosci, Dept Adv Med Sci,Itabashi Ku, Tokyo 1738610, Japan
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Kaiser Permanente, Dept Neurosurg, 1150 Vet Blvd,Tower Bldg,3rd Floor, Redwood City, CA 94070 USA
Stanford Univ, Stanford, CA 94305 USAKaiser Permanente, Dept Neurosurg, 1150 Vet Blvd,Tower Bldg,3rd Floor, Redwood City, CA 94070 USA
Sedrak, Mark
Sabelman, Eric
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Kaiser Permanente, Dept Neurosurg, 1150 Vet Blvd,Tower Bldg,3rd Floor, Redwood City, CA 94070 USAKaiser Permanente, Dept Neurosurg, 1150 Vet Blvd,Tower Bldg,3rd Floor, Redwood City, CA 94070 USA
Sabelman, Eric
Pezeshkian, Patrick
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Kaiser Permanente, Dept Neurosurg, 1150 Vet Blvd,Tower Bldg,3rd Floor, Redwood City, CA 94070 USAKaiser Permanente, Dept Neurosurg, 1150 Vet Blvd,Tower Bldg,3rd Floor, Redwood City, CA 94070 USA
Pezeshkian, Patrick
Duncan, John
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Kaiser Permanente, Dept Neurosurg, 1150 Vet Blvd,Tower Bldg,3rd Floor, Redwood City, CA 94070 USAKaiser Permanente, Dept Neurosurg, 1150 Vet Blvd,Tower Bldg,3rd Floor, Redwood City, CA 94070 USA
Duncan, John
Bernstein, Ivan
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Kaiser Permanente, Dept Neurosurg, 1150 Vet Blvd,Tower Bldg,3rd Floor, Redwood City, CA 94070 USAKaiser Permanente, Dept Neurosurg, 1150 Vet Blvd,Tower Bldg,3rd Floor, Redwood City, CA 94070 USA
Bernstein, Ivan
Bruce, Diana
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Kaiser Permanente, Dept Neurosurg, 1150 Vet Blvd,Tower Bldg,3rd Floor, Redwood City, CA 94070 USAKaiser Permanente, Dept Neurosurg, 1150 Vet Blvd,Tower Bldg,3rd Floor, Redwood City, CA 94070 USA
Bruce, Diana
Tse, Victor
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Kaiser Permanente, Dept Neurosurg, 1150 Vet Blvd,Tower Bldg,3rd Floor, Redwood City, CA 94070 USAKaiser Permanente, Dept Neurosurg, 1150 Vet Blvd,Tower Bldg,3rd Floor, Redwood City, CA 94070 USA
Tse, Victor
Khandhar, Suketu
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Kaiser Permanente, Sacramento Med Ctr & Med Off, Sacramento, CA USAKaiser Permanente, Dept Neurosurg, 1150 Vet Blvd,Tower Bldg,3rd Floor, Redwood City, CA 94070 USA
Khandhar, Suketu
Call, Elena
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Kaiser Permanente, Dept Neurosurg, 1150 Vet Blvd,Tower Bldg,3rd Floor, Redwood City, CA 94070 USAKaiser Permanente, Dept Neurosurg, 1150 Vet Blvd,Tower Bldg,3rd Floor, Redwood City, CA 94070 USA
Call, Elena
Heit, Gary
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Kaiser Permanente, Dept Neurosurg, 1150 Vet Blvd,Tower Bldg,3rd Floor, Redwood City, CA 94070 USAKaiser Permanente, Dept Neurosurg, 1150 Vet Blvd,Tower Bldg,3rd Floor, Redwood City, CA 94070 USA
Heit, Gary
Alaminos-Bouza, Armando
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Mevis Informat Med, Sao Paulo, BrazilKaiser Permanente, Dept Neurosurg, 1150 Vet Blvd,Tower Bldg,3rd Floor, Redwood City, CA 94070 USA