TY - JOUR
T1 - Surgical implantation of STN-DBS leads using intraoperative MRI guidance
T2 - technique, accuracy, and clinical benefit at 1-year follow-up
AU - Chabardes, Stephan
AU - Isnard, Stephanie
AU - Castrioto, Anna
AU - Oddoux, Manuella
AU - Fraix, Valerie
AU - Carlucci, Lore
AU - Payen, Jean François
AU - Krainik, Alexandre
AU - Krack, Paul
AU - Larson, Paul
AU - Le Bas, Jean François
N1 - Publisher Copyright:
© 2015, Springer-Verlag Wien.
PY - 2015/3/19
Y1 - 2015/3/19
N2 - Background: Improvement of surgical accuracy during DBS-lead implantation has been described recently, leading to “frameless” or “MRI-verified“ techniques. However, combining a high-quality definition of the STN using intraoperative 1.5 MRI with the possibility to reduce errors due to co-registration and to monitor lead progression during surgical insertion while checking the absence of surgical complication is an appealing method. We report here surgical methodology, safety, application accuracy, and clinical benefit of STN-lead implantation under MRI guidance. Methods: Two patients with a severe PD state were treated by bilateral STN–DBS. Leads were implanted under general anesthesia using intraoperative MRI guidance (ClearPoint system). Lead implantation accuracy was measured on T1 axial images at the level of the target. Clinical improvement was measured on the pre- and post-UPDRS 3 scale at 1-year follow-up. Results: Surgery was safe and uneventful in both cases. Radial error was 0.36 (right) and 0.86 mm (left) in case 1, and 0.41 (right) and 0.14 mm (left) in case 2. No edema or hemorrhage were noticed. Conclusions: Intraoperative MRI guidance allows DBS lead implantation with high accuracy and with great clinical efficacy. A larger cohort of patients is needed to confirm these initial results.
AB - Background: Improvement of surgical accuracy during DBS-lead implantation has been described recently, leading to “frameless” or “MRI-verified“ techniques. However, combining a high-quality definition of the STN using intraoperative 1.5 MRI with the possibility to reduce errors due to co-registration and to monitor lead progression during surgical insertion while checking the absence of surgical complication is an appealing method. We report here surgical methodology, safety, application accuracy, and clinical benefit of STN-lead implantation under MRI guidance. Methods: Two patients with a severe PD state were treated by bilateral STN–DBS. Leads were implanted under general anesthesia using intraoperative MRI guidance (ClearPoint system). Lead implantation accuracy was measured on T1 axial images at the level of the target. Clinical improvement was measured on the pre- and post-UPDRS 3 scale at 1-year follow-up. Results: Surgery was safe and uneventful in both cases. Radial error was 0.36 (right) and 0.86 mm (left) in case 1, and 0.41 (right) and 0.14 mm (left) in case 2. No edema or hemorrhage were noticed. Conclusions: Intraoperative MRI guidance allows DBS lead implantation with high accuracy and with great clinical efficacy. A larger cohort of patients is needed to confirm these initial results.
KW - DBS
KW - MRI
KW - Parkinson disease
KW - Subthalamic nucleus
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U2 - 10.1007/s00701-015-2361-4
DO - 10.1007/s00701-015-2361-4
M3 - Article
C2 - 25788414
AN - SCOPUS:84925543929
SN - 0001-6268
VL - 157
SP - 729
EP - 737
JO - Acta Neurochirurgica
JF - Acta Neurochirurgica
IS - 4
ER -