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
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
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DOI：
10.1159/000235804
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发表时间：
2009-01-01
影响因子：
1.7
通讯作者：
Treuer, Harald
中科院分区：
文献类型：
--
作者：
Hunsche, Stefan;Sauner, Dieter;Treuer, Harald
目的：在双侧深部脑刺激（DBS）导线植入中植入第一个电极后，通过术中磁共振成像（MRI）量化目标区域和沿着第二个电极的植入轨迹的脑移位效应。我们研究了术中 X 射线成像间接检测脑移位的可行性。方法：对25例接受双侧DBS电极植入的患者，在第一电极植入前后进行X线检查和MRI检查。通过 MRI 数据的非刚性自由变形场分析来评估脑移位的两个参数：沿着前后连合 (AC-PC) 线的整体脑移位和沿着第二电极的植入轨迹的特定脑移位。术前和术中的 X 射线图像经过几何和强度校正，以检测第一电极植入期间颅内空气积聚引起的显着信号变化。结果：植入第一个电极后，在 AC 处观察到大于 1 mm（最大 1.3 mm）的脑移位，并且沿着第二个电极的计划植入轨迹观察到大于 2 mm（最大 2.5 mm）的脑移位。在 1 例患者中，第二个电极的植入轨迹在大脑皮层移位后穿过沟。 9例患者植入第一个电极后，MRI观察到颅内空气量在0.1至38.5 ml之间。颅内空气量大于8ml会引起显着的X射线吸收变化。结论：在双侧 DBS 植入中，脑移位效应可能导致第二电极错位，存在不良或无刺激效应以及不必要的皮层损伤的风险。 DBS 导线植入期间颅内空气侵入导致的 X 射线信号变化的缺乏表明缺乏临床相关的脑移位。版权所有 (C) 2009 S. Karger AG，巴塞尔
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