scholarly journals Two Hundred Twenty-Six Consecutive Deep Brain Stimulation Electrodes Placed Using an “Asleep” Technique and the Neuro|MateTM Robot for the Treatment of Movement Disorders

2020 ◽  
Vol 19 (5) ◽  
pp. 530-538
Author(s):  
Catherine Moran ◽  
Nagaraja Sarangmat ◽  
Carter S Gerard ◽  
Neil Barua ◽  
Reiko Ashida ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Movement Disorders ◽  
Zona Incerta ◽  
Angular Error ◽  
Electrode Placement ◽  
Radial Error ◽  
Lead Placement ◽  
The Mean ◽  
Deep Brain

Abstract BACKGROUND Robotics in neurosurgery has demonstrated widening indications and rapid growth in recent years. Robotic precision and reproducibility are especially pertinent to the field of functional neurosurgery. Deep brain stimulation (DBS) requires accurate placement of electrodes in order to maximize efficacy and minimize side effects. In addition, asleep techniques demand clear target visualization and immediate on-table verification of accuracy. OBJECTIVE To describe the surgical technique of asleep DBS surgery using the Neuro|MateTM Robot (Renishaw plc, Wotton-under-Edge, United Kingdom) and examine the accuracy of DBS lead placement in the subthalamic nucleus (STN) for the treatment of movement disorders. METHODS A single-center retrospective review of 113 patients who underwent bilateral STN/Zona Incerta electrode placement was performed. Accuracy of implantation was assessed using 5 measurements, Euclidian distance, radial error, depth error, angular error, and shift error. RESULTS A total of 226 planned vs actual electrode placements were analyzed. The mean 3-dimensional vector error calculated for 226 trajectories was 0.78 +/− 0.37 mm. The mean radial displacement off planned trajectory was 0.6 +/− 0.33 mm. The mean depth error, angular error, and shift error was 0.4 +/− 0.35 mm, 0.4 degrees, and 0.3 mm, respectively. CONCLUSION This report details our institution's method for DBS lead placement in patients under general anaesthesia using anatomical targeting without microelectrode recordings or intraoperative test stimulation for the treatment of movement disorders. This is the largest reported dataset of accuracy results in DBS surgery performed asleep. This novel robot-assisted operative technique results in sub-millimeter accuracy in DBS electrode placement.

Avoiding the ventricle: a simple step to improve accuracy of anatomical targeting during deep brain stimulation

2009 ◽  
Vol 110 (6) ◽  
pp. 1283-1290 ◽  
Author(s):  
Ludvic Zrinzo ◽  
Arjen L. J. van Hulzen ◽  
Alessandra A. Gorgulho ◽  
Patricia Limousin ◽  
Michiel J. Staal ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Electrode Placement ◽  
Neurosurgical Procedures ◽  
Electrode Implantation ◽  
Clinical Observations ◽  
Simple Step ◽  
The Mean ◽  
The Impact ◽  
Deep Brain

Object The authors examined the accuracy of anatomical targeting during electrode implantation for deep brain stimulation in functional neurosurgical procedures. Special attention was focused on the impact that ventricular involvement of the electrode trajectory had on targeting accuracy. Methods The targeting error during electrode placement was assessed in 162 electrodes implanted in 109 patients at 2 centers. The targeting error was calculated as the shortest distance from the intended stereotactic coordinates to the final electrode trajectory as defined on postoperative stereotactic imaging. The trajectory of these electrodes in relation to the lateral ventricles was also analyzed on postoperative images. Results The trajectory of 68 electrodes involved the ventricle. The targeting error for all electrodes was calculated: the mean ± SD and the 95% CI of the mean was 1.5 ± 1.0 and 0.1 mm, respectively. The same calculations for targeting error for electrode trajectories that did not involve the ventricle were 1.2 ± 0.7 and 0.1 mm. A significantly larger targeting error was seen in trajectories that involved the ventricle (1.9 ± 1.1 and 0.3 mm; p < 0.001). Thirty electrodes (19%) required multiple passes before final electrode implantation on the basis of physiological and/or clinical observations. There was a significant association between an increased requirement for multiple brain passes and ventricular involvement in the trajectory (p < 0.01). Conclusions Planning an electrode trajectory that avoids the ventricles is a simple precaution that significantly improves the accuracy of anatomical targeting during electrode placement for deep brain stimulation. Avoidance of the ventricles appears to reduce the need for multiple passes through the brain to reach the desired target as defined by clinical and physiological observations.

719 Deep Brain Stimulation for Movement Disorders: Lead Placement without Microelectrode Recording

Neurosurgery ◽  
2001 ◽  
Vol 49 (2) ◽  
pp. 512
Author(s):  
Istvan Takacs ◽  
Scott J. Sherman ◽  
Randy S. Bell ◽  
Oren N. Gottfried ◽  
Dennis Way ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Movement Disorders ◽  
Microelectrode Recording ◽  
Lead Placement ◽  
Deep Brain

Hyperhidrosis due to deep brain stimulation in a patient with essential tremor

2007 ◽  
Vol 107 (5) ◽  
pp. 1036-1038 ◽  
Author(s):  
Alan Diamond ◽  
Christopher Kenney ◽  
Michael Almaguer ◽  
Joseph Jankovic
Keyword(s):  
Deep Brain Stimulation ◽  
Essential Tremor ◽  
Brain Stimulation ◽  
Side Effect ◽  
Rare Complication ◽  
Zona Incerta ◽  
Electrode Placement ◽  
Anterior Thalamus ◽  
The Brain ◽  
Deep Brain

✓The authors present a unique case of hyperhidrosis as a side effect of a misplaced deep brain stimulation (DBS) electrode near the ventrointermedius (Vim) nucleus in a patient with essential tremor. Magnetic resonance imaging of the brain showed electrode placement in the left anterior thalamus traversing the hypothalamus. High-frequency electrical stimulation possibly resulted in unilateral activation of the efferent sympathetic pathways in the zona incerta. Although a rare complication, hypothalamic dysfunction may occur as a stimulation-related side effect of Vim-DBS.

scholarly journals Multitarget deep brain stimulation for clinically complex movement disorders

2020 ◽  
pp. 1-6 ◽  
Author(s):  
Tariq Parker ◽  
Ashley L. B. Raghu ◽  
James J. FitzGerald ◽  
Alexander L. Green ◽  
Tipu Z. Aziz
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Movement Disorders ◽  
Electrode Placement ◽  
Rational Approach ◽  
Pallidal Stimulation ◽  
Holmes Tremor ◽  
Brainstem Stroke ◽  
Complex Movement ◽  
Deep Brain

Deep brain stimulation (DBS) of single-target nuclei has produced remarkable functional outcomes in a number of movement disorders such as Parkinson’s disease, essential tremor, and dystonia. While these benefits are well established, DBS efficacy and strategy for unusual, unclassified movement disorder syndromes is less clear. A strategy of dual pallidal and thalamic electrode placement is a rational approach in such cases where there is profound, medically refractory functional impairment. The authors report a series of such cases: midbrain cavernoma hemorrhage with olivary hypertrophy, spinocerebellar ataxia-like disorder of probable genetic origin, Holmes tremor secondary to brainstem stroke, and hemiballismus due to traumatic thalamic hemorrhage, all treated by dual pallidal and thalamic DBS. All patients demonstrated robust benefit from DBS, maintained in long-term follow-up. This series demonstrates the flexibility and efficacy, but also the limitations, of dual thalamo-pallidal stimulation for managing axial and limb symptoms of tremors, dystonia, chorea, and hemiballismus in patients with complex movement disorders.

scholarly journals A systematic review of deep brain stimulation for the treatment of drug-resistant epilepsy in childhood

2019 ◽  
Vol 23 (3) ◽  
pp. 274-284 ◽  
Author(s):  
Han Yan ◽  
Eric Toyota ◽  
Melanie Anderson ◽  
Taylor J. Abel ◽  
Elizabeth Donner ◽  
...  
Keyword(s):  
Systematic Review ◽  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Zona Incerta ◽  
Electrode Placement ◽  
Patient Specific ◽  
Seizure Freedom ◽  
Drug Resistant ◽  
Drug Resistant Epilepsy ◽  
Deep Brain

OBJECTIVEDrug-resistant epilepsy (DRE) presents a therapeutic challenge in children, necessitating the consideration of multiple treatment options. Although deep brain stimulation (DBS) has been studied in adults with DRE, little evidence is available to guide clinicians regarding the application of this potentially valuable tool in children. Here, the authors present the first systematic review aimed at understanding the safety and efficacy of DBS for DRE in pediatric populations, emphasizing patient selection, device placement and programming, and seizure outcomes.METHODSThe systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and recommendations. Relevant articles were identified from 3 electronic databases (MEDLINE, Embase, and Cochrane CENTRAL) from their inception to November 17, 2017. Inclusion criteria of individual studies were 1) diagnosis of DRE; 2) treatment with DBS; 3) inclusion of at least 1 pediatric patient (age ≤ 18 years); and 4) patient-specific data. Exclusion criteria for the systematic review included 1) missing data for age, DBS target, or seizure freedom; 2) nonhuman subjects; and 3) editorials, abstracts, review articles, and dissertations.RESULTSThis review identified 21 studies and 40 unique pediatric patients (ages 4–18 years) who received DBS treatment for epilepsy. There were 18 patients with electrodes placed in the bilateral or unilateral centromedian nucleus of the thalamus (CM) electrodes, 8 patients with bilateral anterior thalamic nucleus (ATN) electrodes, 5 patients with bilateral and unilateral hippocampal electrodes, 3 patients with bilateral subthalamic nucleus (STN) and 1 patient with unilateral STN electrodes, 2 patients with bilateral posteromedial hypothalamus electrodes, 2 patients with unilateral mammillothalamic tract electrodes, and 1 patient with caudal zona incerta electrode placement. Overall, 5 of the 40 (12.5%) patients had an International League Against Epilepsy class I (i.e., seizure-free) outcome, and 34 of the 40 (85%) patients had seizure reduction with DBS stimulation.CONCLUSIONSDBS is an alternative or adjuvant treatment for children with DRE. Prospective registries and future clinical trials are needed to identify the optimal DBS target, although favorable outcomes are reported with both CM and ATN in children.

719 Deep Brain Stimulation for Movement Disorders: Lead Placement without Microelectrode Recording

Neurosurgery ◽  
2001 ◽  
Vol 49 (2) ◽  
pp. 512-512
Author(s):  
Istvan Takacs ◽  
Scott J. Sherman ◽  
Randy S. Bell ◽  
Oren N. Gottfried ◽  
Dennis Way ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Movement Disorders ◽  
Microelectrode Recording ◽  
Lead Placement ◽  
Deep Brain

scholarly journals Stereotactic ROBOT-Assisted Deep Brain Stimulation Workflow: Incorporating the ROSA-Brain System Into the Functional Neurosurgical Practice

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Amir H Faraji ◽  
Vasileios Kokkinos ◽  
James C Sweat ◽  
Robert M Richardson
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Human Error ◽  
Neurosurgical Procedures ◽  
Robotic Assisted ◽  
Microelectrode Recordings ◽  
Radial Error ◽  
Lead Placement ◽  
Significant Difference ◽  
Deep Brain

Abstract INTRODUCTION Modern robotic-assisted stereotaxy has been increasingly adopted for neurosurgical procedures. Accuracy and precision are paramount in deep brain stimulation (DBS) surgery, and robotic control may improve surgical outcomes and precision. We developed 2 frame-based workflows for DBS: (1) without microelectrode recordings and (2) with microelectrode recordings and the possibility for intraoperative electrocorticography, and reported on lead placement accuracy and complications. METHODS A consecutive single-surgeon cohort of 20 patients underwent stage 1 DBS (targets included VIM, STN, GPi) with frame-based ROSA-Brain robotic assistance. Radial error accuracy was retrospectively established with two blinded raters comparing pre- and postoperative DBS lead trajectories. Total operative case time was obtained from nursing documentation and postoperative complications were documented. RESULTS A systematic method for ROSA-Brain co-registration was developed to allow for DBS: (1) without microelectrode recordings and (2) with microelectrode recordings and the possibility for intraoperative electrocorticography. The overall radial error for lead placement across all 20 patients was 1.14+/−0.11 mm. A significant difference (P = .006) existed between the radial error of the first 10 patients (1.46+/−0.19 mm) as compared to the second 10 patients (0.86+/−0.09 mm). Overall, the total OR case time is at par with previously reported robotic-assisted DBS cases. CONCLUSION Robotic-assisted DBS surgery, such as with the ROSA-Brain platform, has the potential to increase precision and reduce the human error associated with multiple measurements using traditional frame-based surgery without significantly impacting operating room workflow.

Interventional MRI–guided deep brain stimulation in pediatric dystonia: first experience with the ClearPoint system

2014 ◽  
Vol 14 (4) ◽  
pp. 400-408 ◽  
Author(s):  
Philip A. Starr ◽  
Leslie C. Markun ◽  
Paul S. Larson ◽  
Monica M. Volz ◽  
Alastair J. Martin ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Adverse Events ◽  
Real Time ◽  
Brain Stimulation ◽  
Interventional Mri ◽  
Lead Placement ◽  
The Mean ◽  
Mri Guided ◽  
Lead Location ◽  
Deep Brain

Object The placement of deep brain stimulation (DBS) leads in adults is traditionally performed using physiological confirmation of lead location in the awake patient. Most children are unable to tolerate awake surgery, which poses a challenge for intraoperative confirmation of lead location. The authors have developed an interventional MRI (iMRI)–guided procedure to allow for real-time anatomical imaging, with the goal of achieving very accurate lead placement in patients who are under general anesthesia. Methods Six pediatric patients with primary dystonia were prospectively enrolled. Patients were candidates for surgery if they had marked disability and medical therapy had been ineffective. Five patients had the DYT1 mutation, and mean age at surgery was 11.0 ± 2.8 years. Patients underwent bilateral globus pallidus internus (GPi, n = 5) or sub-thalamic nucleus (STN, n = 1) DBS. The leads were implanted using a novel skull-mounted aiming device in conjunction with dedicated software (ClearPoint system), used within a 1.5-T diagnostic MRI unit in a radiology suite, without physiological testing. The Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) was used at baseline, 6 months, and 12 months postoperatively. Further measures included lead placement accuracy, quality of life, adverse events, and stimulation settings. Results A single brain penetration was used for placement of all 12 leads. The mean difference (± SD) between the intended target location and the actual lead location, in the axial plane passing through the intended target, was 0.6 ± 0.5 mm, and the mean surgical time (leads only) was 190 ± 26 minutes. The mean percent improvement in the BFMDRS movement scores was 86.1% ± 12.5% at 6 months (n = 6, p = 0.028) and 87.6% ± 19.2% at 12 months (p = 0.028). The mean stimulation settings at 12 months were 3.0 V, 83 μsec, 135 Hz for GPi DBS, and 2.1 V, 60 μsec, 145 Hz for STN DBS). There were no serious adverse events. Conclusions Interventional MRI–guided DBS using the ClearPoint system was extremely accurate, provided real-time confirmation of DBS placement, and could be used in any diagnostic MRI suite. Clinical outcomes for pediatric dystonia are comparable with the best reported results using traditional frame-based stereotaxy. Clinical trial registration no.: NCT00792532 (ClinicalTrials.gov).

scholarly journals Neurophysiological biomarkers to optimize deep brain stimulation in movement disorders

2021 ◽  
Author(s):  
Daniel Sirica ◽  
Angela L Hewitt ◽  
Christopher G Tarolli ◽  
Miriam T Weber ◽  
Carol Zimmerman ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Local Field ◽  
Brain Stimulation ◽  
Movement Disorders ◽  
High Frequency ◽  
Field Potentials ◽  
Beta Band ◽  
Pathological Characteristics ◽  
Lead Placement ◽  
Deep Brain

Intraoperative neurophysiological information could increase accuracy of surgical deep brain stimulation (DBS) lead placement. Subsequently, DBS therapy could be optimized by specifically targeting pathological activity. In Parkinson’s disease, local field potentials (LFPs) excessively synchronized in the beta band (13–35 Hz) correlate with akinetic-rigid symptoms and their response to DBS therapy, particularly low beta band suppression (13–20 Hz) and high frequency gamma facilitation (35–250 Hz). In dystonia, LFPs abnormally synchronize in the theta/alpha (4–13 Hz), beta and gamma (60–90 Hz) bands. Phasic dystonic symptoms and their response to DBS correlate with changes in theta/alpha synchronization. In essential tremor, LFPs excessively synchronize in the theta/alpha and beta bands. Adaptive DBS systems will individualize pathological characteristics of neurophysiological signals to automatically deliver therapeutic DBS pulses of specific spatial and temporal parameters.

scholarly journals Fixed-Life or Rechargeable Batteries for Deep Brain Stimulation: Preference and Satisfaction Among Patients With Hyperkinetic Movement Disorders

2021 ◽  
Vol 12 ◽  
Author(s):  
Xian Qiu ◽  
Yuhan Wang ◽  
Zhengyu Lin ◽  
Yunhao Wu ◽  
Wenying Xu ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Movement Disorders ◽  
Rechargeable Batteries ◽  
Economic Factors ◽  
Pulse Generators ◽  
The Mean ◽  
Implanted Device ◽  
Deep Brain ◽  
Main Factor

Background: Deep brain stimulation (DBS) is an established treatment for hyperkinetic movement disorders. Patients undergoing DBS can choose between the use of a rechargeable or non-rechargeable battery for implanted pulse generators (IPG).Objectives: In this study, we aimed to evaluate patient preferences and satisfaction with rechargeable and non-rechargeable batteries for IPGs after undergoing DBS.Methods: Overall, 100 patients with hyperkinetic movement disorders (dystonia: 79, Tourette syndrome: 21) who had undergone DBS took a self-designed questionnaire to assess their satisfaction and experience with the type of battery they had chosen and the factors influencing their choice.Results: Of the participants, 87% were satisfied with the stimulating effects of the treatment as well as the implanted device; 76% had chosen rechargeable devices (r-IPGs), 71.4% of whom recharged the battery themselves. Economic factors were the main reason for choosing both r-IPG and non-rechargeable IPG (nr-IPG). The questionnaire revealed that 66% of the patients checked their r-IPG battery every week. The mean interval for battery recharge was 4.3 days.Conclusions: The majority of the patients were satisfied with their in-service-IPG, regardless of whether it was a r-IPG or nr-IPG. Affordability was the main factor influencing the choice of IPG. The majority of the patients were confident in recharging the battery of their r-IPG themselves; only 11% of patients experienced difficulties. Understanding the recharge process remains difficult for some patients and increasing the number of training sessions for the device may be helpful.

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