TY - JOUR
T1 - The Magnetic Resonance Imaging (MRI)-Directed Implantable Guide Tube Technique
T2 - Accuracy and Applications in Deep Brain Stimulation
AU - Chandran, Arjun S.
AU - Thani, Nova B.
AU - Bangash, Omar K.
AU - Lind, Christopher R.P.
PY - 2021/7
Y1 - 2021/7
N2 - 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.
AB - 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.
KW - Accuracy
KW - Deep brain stimulation
KW - Direct targeting
UR - http://www.scopus.com/inward/record.url?scp=85107827728&partnerID=8YFLogxK
U2 - 10.1016/j.wneu.2021.05.048
DO - 10.1016/j.wneu.2021.05.048
M3 - Article
C2 - 34044164
AN - SCOPUS:85107827728
SN - 1878-8750
VL - 151
SP - e1016-e1023
JO - World Neurosurgery
JF - World Neurosurgery
ER -