The Magnetic Resonance Imaging (MRI)-Directed Implantable Guide Tube Technique: Accuracy and Applications in Deep Brain Stimulation

Arjun S. Chandran, Nova B. Thani, Omar K. Bangash, Christopher R.P. Lind

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)

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.

Original languageEnglish
Pages (from-to)e1016-e1023
JournalWorld Neurosurgery
Volume151
Early online date24 May 2021
DOIs
Publication statusPublished - Jul 2021

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