| Subthalamic nucleus deep brain stimulator placement using high-field interventional magnetic resonance imaging and a skull-mounted aiming device: technique and application accuracy. | |
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MedLine Citation:
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PMID: 19681683 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECT: The authors discuss their method for placement of deep brain stimulation (DBS) electrodes using interventional MR (iMR) imaging and report on the accuracy of the technique, its initial clinical efficacy, and associated complications in a consecutive series of subthalamic nucleus (STN) DBS implants to treat Parkinson disease (PD). METHODS: A skull-mounted aiming device (Medtronic NexFrame) was used in conjunction with real-time MR imaging (Philips Intera 1.5T). Preoperative imaging, DBS implantation, and postimplantation MR imaging were integrated into a single procedure performed with the patient in a state of general anesthesia. Accuracy of implantation was assessed using 2 types of measurements: the "radial error," defined as the scalar distance between the location of the intended target and the actual location of the guidance sheath in the axial plane 4 mm inferior to the commissures, and the "tip error," defined as the vector distance between the expected anterior commissure-posterior commissure (AC-PC) coordinates of the permanent DBS lead tip and the actual AC-PC coordinates of the lead tip. Clinical outcome was assessed using the Unified Parkinson's Disease Rating Scale part III (UPDRS III), in the off-medication state. RESULTS: Twenty-nine patients with PD underwent iMR imaging-guided placement of 53 DBS electrodes into the STN. The mean (+/- SD) radial error was 1.2 +/- 0.65 mm, and the mean absolute tip error was 2.2 +/- 0.92 mm. The tip error was significantly smaller than for STN DBS electrodes implanted using traditional frame-based stereotaxy (3.1 +/- 1.41 mm). Eighty-seven percent of leads were placed with a single brain penetration. No hematomas were visible on MR images. Two device infections occurred early in the series. In bilaterally implanted patients, the mean improvement on the UPDRS III at 9 months postimplantation was 60%. CONCLUSIONS: The authors' technical approach to placement of DBS electrodes adapts the procedure to a standard configuration 1.5-T diagnostic MR imaging scanner in a radiology suite. This method simplifies DBS implantation by eliminating the use of the traditional stereotactic frame and the subsequent requirement for registration of the brain in stereotactic space and the need for physiological recording and patient cooperation. This method has improved accuracy compared with that of anatomical guidance using standard frame-based stereotaxy in conjunction with preoperative MR imaging. |
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Authors:
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Philip A Starr; Alastair J Martin; Jill L Ostrem; Pekka Talke; Nadja Levesque; Paul S Larson |
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Publication Detail:
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Type: Comparative Study; Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Journal of neurosurgery Volume: 112 ISSN: 1933-0693 ISO Abbreviation: J. Neurosurg. Publication Date: 2010 Mar |
Date Detail:
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Created Date: 2010-03-02 Completed Date: 2010-04-08 Revised Date: 2011-07-25 |
Medline Journal Info:
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Nlm Unique ID: 0253357 Medline TA: J Neurosurg Country: United States |
Other Details:
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Languages: eng Pagination: 479-90 Citation Subset: AIM; IM |
Affiliation:
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Department of Neurosurgery, University of California, San Francisco, California 94143, USA. starrp@neurosurg.ucsf.edu |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Anesthesia, General Deep Brain Stimulation / adverse effects, methods* Electrodes, Implanted / adverse effects Follow-Up Studies Humans Magnetic Resonance Imaging, Interventional* Middle Aged Neurosurgical Procedures* / adverse effects, instrumentation, methods Parkinson Disease / physiopathology, surgery, therapy* Skull Stereotaxic Techniques Subthalamic Nucleus* / physiopathology, surgery Time Factors Treatment Outcome |
| Grant Support | |
ID/Acronym/Agency:
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R21 EB008888-01A1/EB/NIBIB NIH HHS |
| Comments/Corrections | |
Comment In:
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J Neurosurg. 2010 Mar;112(3):477; discussion 477-8
[PMID:
19681686
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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