An Evaluation of Hardware and Surgical Complications with Deep Brain Stimulation Based on Diagnosis and Lead Location

2012 ◽  
Vol 90 (3) ◽  
pp. 173-180 ◽  
Author(s):  
Steven Falowski ◽  
Yinn Cher Ooi ◽  
Adam Smith ◽  
Leonard Verhargen Metman ◽  
Roy A.E. Bakay
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Surgical Complications ◽  
Lead Location ◽  
Deep Brain

scholarly journals Impact of an Interdisciplinary Deep Brain Stimulation Screening Model on Post-Surgical Complications in Essential Tremor Patients

PLoS ONE ◽  
2015 ◽  
Vol 10 (12) ◽  
pp. e0145623 ◽  
Author(s):  
Masa-aki Higuchi ◽  
Dan D. Topiol ◽  
Bilal Ahmed ◽  
Hokuto Morita ◽  
Samuel Carbunaru ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Essential Tremor ◽  
Brain Stimulation ◽  
Surgical Complications ◽  
Screening Model ◽  
Deep Brain

scholarly journals Outcomes following deep brain stimulation lead revision or reimplantation for Parkinson’s disease

2019 ◽  
Vol 130 (6) ◽  
pp. 1841-1846 ◽  
Author(s):  
Leonardo A. Frizon ◽  
Sean J. Nagel ◽  
Francis J. May ◽  
Jianning Shao ◽  
Andres L. Maldonado-Naranjo ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Device Failure ◽  
Suboptimal Outcome ◽  
Number Of Patients ◽  
The Mean ◽  
Lead Location ◽  
Deep Brain

OBJECTIVEThe number of patients who benefit from deep brain stimulation (DBS) for Parkinson’s disease (PD) has increased significantly since the therapy was first approved by the FDA. Suboptimal outcomes, infection, or device failure are risks of the procedure and may require lead removal or repositioning. The authors present here the results of their series of revision and reimplantation surgeries.METHODSThe data were reviewed from all DBS intracranial lead removals, revisions, or reimplantations among patients with PD over a 6-year period at the authors’ institution. The indications for these procedures were categorized as infection, suboptimal outcome, and device failure. Motor outcomes as well as lead location were analyzed before removal and after reimplant or revision.RESULTSThe final sample included 25 patients who underwent 34 lead removals. Thirteen patients had 18 leads reimplanted after removal. There was significant improvement in the motor scores after revision surgery among the patients who had the lead revised for a suboptimal outcome (p = 0.025). The mean vector distance of the new lead location compared to the previous location was 2.16 mm (SD 1.17), measured on an axial plane 3.5 mm below the anterior commissure–posterior commissure line. When these leads were analyzed by subgroup, the mean distance was 1.67 mm (SD 0.83 mm) among patients treated for infection and 2.73 mm (SD 1.31 mm) for those with suboptimal outcomes.CONCLUSIONSPatients with PD who undergo reimplantation surgery due to suboptimal outcome may experience significant benefits. Reimplantation after surgical infection seems feasible and overall safe.

The Impact of Microelectrode Recording on Lead Location in Deep Brain Stimulation for the Treatment of Movement Disorders

2019 ◽  
Vol 132 ◽  
pp. e487-e495
Author(s):  
Ryan B. Kochanski ◽  
Sander Bus ◽  
Bledi Brahimaj ◽  
Alireza Borghei ◽  
Kristen L. Kraimer ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Movement Disorders ◽  
Microelectrode Recording ◽  
Lead Location ◽  
The Impact ◽  
Deep Brain

Deep brain stimulation compared with bariatric surgery for the treatment of morbid obesity: a decision analysis study

2010 ◽  
Vol 29 (2) ◽  
pp. E15 ◽  
Author(s):  
Jared M. Pisapia ◽  
Casey H. Halpern ◽  
Noel N. Williams ◽  
Thomas A. Wadden ◽  
Gordon H. Baltuch ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Morbid Obesity ◽  
Sensitivity Analysis ◽  
Gastric Bypass ◽  
Deep Brain Stimulation ◽  
Decision Analysis ◽  
Success Rate ◽  
Brain Stimulation ◽  
Surgical Complications ◽  
Deep Brain

Object Roux-en-Y gastric bypass is the gold standard treatment for morbid obesity, although failure rates may be high, particularly in patients with a BMI > 50 kg/m2. With improved understanding of the neuropsychiatric basis of obesity, deep brain stimulation (DBS) offers a less invasive and reversible alternative to available surgical treatments. In this decision analysis, the authors determined the success rate at which DBS would be equivalent to the two most common bariatric surgeries. Methods Medline searches were performed for studies of laparoscopic adjustable gastric banding (LAGB), laparoscopic Roux-en-Y gastric bypass (LRYGB), and DBS for movement disorders. Bariatric surgery was considered successful if postoperative excess weight loss exceeded 45% at 1-year follow-up. Using complication and success rates from the literature, the authors constructed a decision analysis model for treatment by LAGB, LRYGB, DBS, or no surgical treatment. A sensitivity analysis in which major parameters were systematically varied within their 95% CIs was used. Results Fifteen studies involving 3489 and 3306 cases of LAGB and LRYGB, respectively, and 45 studies involving 2937 cases treated with DBS were included. The operative successes were 0.30 (95% CI 0.247–0.358) for LAGB and 0.968 (95% CI 0.967–0.969) for LRYGB. Sensitivity analysis revealed utility of surgical complications in LRYGB, probability of surgical complications in DBS, and success rate of DBS as having the greatest influence on outcomes. At no values did LAGB result in superior outcomes compared with other treatments. Conclusions Deep brain stimulation must achieve a success rate of 83% to be equivalent to bariatric surgery. This high-threshold success rate is probably due to the reported success rate of LRYGB, despite its higher complication rate (33.4%) compared with DBS (19.4%). The results support further research into the role of DBS for the treatment of obesity.

scholarly journals Microstimulation Is a Promising Approach in Achieving Better Lead Placement in Subthalamic Nucleus Deep Brain Stimulation Surgery

2021 ◽  
Vol 12 ◽  
Author(s):  
Lin Shi ◽  
Shiying Fan ◽  
Tianshuo Yuan ◽  
Huaying Fang ◽  
Jie Zheng ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Subthalamic Nucleus ◽  
Brain Stimulation ◽  
Neuronal Firing ◽  
Lead Placement ◽  
Imaging Reconstruction ◽  
Neurophysiological Data ◽  
Lead Location ◽  
Deep Brain Stimulation Surgery ◽  
Deep Brain

Background: The successful application of subthalamic nucleus (STN) deep brain stimulation (DBS) surgery relies mostly on optimal lead placement, whereas the major challenge is how to precisely localize STN. Microstimulation, which can induce differentiating inhibitory responses between STN and substantia nigra pars reticulata (SNr) near the ventral border of STN, has indicated a great potential of breaking through this barrier.Objective: This study aims to investigate the feasibility of localizing the boundary between STN and SNr (SSB) using microstimulation and promote better lead placement.Methods: We recorded neurophysiological data from 41 patients undergoing STN-DBS surgery with microstimulation in our hospital. Trajectories with typical STN signal were included. Microstimulation was applied near the bottom of STN to determine SSB, which was validated by the imaging reconstruction of DBS leads.Results: In most trajectories with microstimulation (84.4%), neuronal firing in STN could not be inhibited by microstimulation, whereas in SNr long inhibition was observed following microstimulation. The success rate of localizing SSB was significantly higher in trajectories with microstimulation than those without. Moreover, results from imaging reconstruction and intraoperative neurological assessments demonstrated better lead location and higher therapeutic effectiveness in trajectories with microstimulation and accurately identified SSB.Conclusion: Microstimulation on microelectrode recording is an effective approach to localize the SSB. Our data provide clinical evidence that microstimulation can be routinely employed to achieve better lead placement.

What You See Is What You Get: Lead Location Within Deep Brain Structures Is Accurately Depicted by Stereotactic Magnetic Resonance Imaging

2015 ◽  
Vol 11 (3) ◽  
pp. 412-419 ◽  
Author(s):  
Jonathan A Hyam ◽  
Harith Akram ◽  
Thomas Foltynie ◽  
Patricia Limousin ◽  
Marwan Hariz ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Deep Brain Stimulation ◽  
Magnetic Resonance ◽  
Brain Stimulation ◽  
Anterior Commissure ◽  
Brain Structures ◽  
Lead Removal ◽  
Resonance Imaging ◽  
Lead Location ◽  
Deep Brain

Abstract BACKGROUND Magnetic resonance imaging (MRI)-verified deep brain stimulation relies on the correct interpretation of stereotactic imaging documenting lead location in relation to visible anatomic target. However, it has been suggested that local signal distortion from the lead itself renders its depiction on MRI unreliable. OBJECTIVE To compare lead location on stereotactic MRI with subsequent location of its brain track after removal. METHODS Patients underwent deep brain stimulation with the use of MRI-guided and MRI-verified Leksell frame approach. Infection or suboptimal efficacy required lead removal and subsequent reimplantation by using the same technique. Postimplantation stereotactic MR images were analyzed. Lateral (x) and anteroposterior (y) distances from midcommissural point to center of the lead hypointensity were recorded at the anterior commissure-posterior commissure plane (pallidal electrode) or z = −4 (subthalamic electrode). Stereotactic MRI before the second procedure, x and y distances from the center of the visible lead track hypointensity to midcommissural point were independently recorded. Vectorial distance from center of the lead hypointensity to the center of its track was calculated. RESULTS Sixteen electrode tracks were studied in 10 patients. Mean differences between lead artifact location and lead track location were: x coordinate 0.4 mm ± 0.2; y coordinate 0.6 mm ± 0.3. Mean vectorial distance was 0.7 mm ± 0.2. CONCLUSION Stereotactic distance between lead location and subsequent brain track location on MRI was small. The mean discrepancy was approximately half the deep brain stimulation lead width. This suggests that lead hypointensity seen on postimplantation MRI is indeed an accurate representation of its real location within deep brain structures.

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