Intraoperative magnetic resonance imaging findings during deep brain stimulation surgery Clinical article
Intraoperative magnetic resonance imaging findings during deep brain stimulation surgery Clinical article
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DOI：
10.3171/2011.5.jns101457
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发表时间：
2011-10-01
影响因子：
4.1
通讯作者：
Huston, John, III
中科院分区：
文献类型：
--
作者：
Huston, Olivia O.;Watson, Robert E.;Huston, John, III
Object.脑深部电刺激（DBS）是一种成熟的神经外科技术，用于治疗各种神经系统疾病，包括帕金森病、特发性震颤、肌张力障碍、癫痫、抑郁症和强迫症。本研究报告了在DBS手术中使用术中MR成像来评估急性出血、颅内空气、脑移位和电极导线放置的准确性。在46个月期间，143例患者接受了152例DBS手术，包括289例使用术中1.5 T MR成像的电极导线置入。由MR成像物理学家监督成像，以保持比吸收率低于0.1 W/kg的要求水平，并始终包括T1磁化准备的快速梯度回波和T2* 梯度回波序列，并选择使用T2液体衰减反转恢复（FLAIR）和T2快速自旋回波（FSE）。对术中MRI检查进行回顾性分析，以量化DBS手术期间的出血量和引入的空气量。术中MRI检查显示9例患者中5例硬膜下血肿，3例蛛网膜下腔出血，1例脑实质内出血。仅1例发生蛛网膜下腔出血的患者出现临床明显症状，包括短暂性重度头痛和轻度意识模糊。在144个独立的病例中确定了由于颅内空气导致的脑移位。术中MR成像可以安全地进行，并且可以帮助显示DBS手术期间涉及颅内出血和空气的急性变化。这些发现很少具有临床意义，通常在随访成像前消退。选择性使用T2 FLAIR和T2 FSE成像可以确认出血或空气的存在，并排除CT检查的需要。(DOI：10.3171/2011.5.JNS101457）
Object. Deep brain stimulation (DBS) is an established neurosurgical technique used to treat a variety of neurological disorders, including Parkinson disease, essential tremor, dystonia, epilepsy, depression, and obsessive-compulsive disorder. This study reports on the use of intraoperative MR imaging during DBS surgery to evaluate acute hemorrhage, intracranial air, brain shift, and accuracy of lead placement.Methods. During a 46-month period, 143 patients underwent 152 DBS surgeries including 289 lead placements utilizing intraoperative 1.5-T MR imaging. Imaging was supervised by an MR imaging physicist to maintain the specific absorption rate below the required level of 0.1 W/kg and always included T1 magnetization-prepared rapid gradient echo and T2* gradient echo sequences with selected use of T2 fluid attenuated inversion recovery (FLAIR) and T2 fast spin echo (FSE). Retrospective review of the intraoperative MR imaging examinations was performed to quantify the amount of hemorrhage and the amount of air introduced during the DBS surgery.Results. Intraoperative MR imaging revealed 5 subdural hematomas, 3 subarachnoid hemorrhages, and 1 intraparenchymal hemorrhage in 9 of the 143 patients. Only 1 patient experiencing a subarachnoid hemorrhage developed clinically apparent symptoms, which included transient severe headache and mild confusion. Brain shift due to intracranial air was identified in 144 separate instances.Conclusions. Intraoperative MR imaging can be safely performed and may assist in demonstrating acute changes involving intracranial hemorrhage and air during DBS surgery. These findings are rarely clinically significant and typically resolve prior to follow-up imaging. Selective use of T2 FLAIR and T2 FSE imaging can confirm the presence of hemorrhage or air and preclude the need for CT examinations. (DOI: 10.3171/2011.5.JNS101457)