Navigated Deep Brain Stimulation Surgery: Evaluating the Combined Use of a Frame-Based Stereotactic System and a Navigation System

2020 ◽  
pp. 1-7
Author(s):  
Marie T. Krüger ◽  
Bálint Várkuti ◽  
Jörg Achinger ◽  
Volker A. Coenen ◽  
Thomas Prokop ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Navigation System ◽  
Phantom Study ◽  
Teaching Tool ◽  
Navigation Systems ◽  
Combined Approach ◽  
Set Up ◽  
Potential Use ◽  
Deep Brain

Deep brain stimulation (DBS) is a complex surgical procedure that requires detailed anatomical knowledge. In many fields of neurosurgery navigation systems are used to display anatomical structures during an operation to aid performing these surgeries. In frame-based DBS, the advantage of visualization has not yet been evaluated during the procedure itself. In this study, we added live visualization to a frame-based DBS system, using a standard navigation system and investigated its accuracy and potential use in DBS surgery. As a first step, a phantom study was conducted to investigate the accuracy of the navigation system in conjunction with a frame-based approach. As a second step, 5 DBS surgeries were performed with this combined approach. Afterwards, 3 neurosurgeons and 2 neurologists with different levels of experience evaluated the potential use of the system with a questionnaire. Moreover, the additional personnel, costs and required set up time were noted and compared to 5 consecutive standard procedures. In the phantom study, the navigation system showed an inaccuracy of 2.1 mm (mean SD 0.69 mm). In the questionnaire, a mean of 9.4/10 points was awarded for the use of the combined approach as a teaching tool, a mean of 8.4/10 for its advantage in creating a 3-dimensional (3-D) map and a mean of 8/10 points for facilitating group discussions. Especially neurosurgeons and neurologists in training found it useful to better interpret clinical results and side effects (mean 9/10 points) and neurosurgeons appreciated its use to better interpret microelectrode recordings (mean 9/10 points). A mean of 6/10 points was awarded when asked if the benefits were worth the additional efforts. Initially 2 persons, then one additional person was required to set up the system with no relevant added time or costs. Using a navigation system for live visualization during frame-based DBS surgery can improve the understanding of the complex 3-D anatomy and many aspects of the procedure itself. For now, we would regard it as an excellent teaching tool rather than a necessity to perform DBS surgeries.

scholarly journals False-positive analysis of functional MRI during simulated deep brain stimulation: A phantom study

2008 ◽  
Vol 27 (6) ◽  
pp. 1439-1442 ◽  
Author(s):  
Ho-Ling Liu ◽  
Hsin-Mei Chen ◽  
Yu-Chien Wu ◽  
Siew-Na Lim ◽  
Chih-Mao Huang ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Functional Mri ◽  
Brain Stimulation ◽  
False Positive ◽  
Phantom Study ◽  
Positive Analysis ◽  
Deep Brain

3-Tesla MRI in patients with fully implanted deep brain stimulation devices: a preliminary study in 10 patients

2017 ◽  
Vol 127 (4) ◽  
pp. 892-898 ◽  
Author(s):  
Francesco Sammartino ◽  
Vibhor Krishna ◽  
Tejas Sankar ◽  
Jason Fisico ◽  
Suneil K. Kalia ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Pulse Generator ◽  
Safety Data ◽  
Phantom Study ◽  
Maximum Temperature ◽  
Clinical Safety ◽  
Internal Pulse Generator ◽  
Neurological Effects ◽  
Deep Brain

OBJECTIVEThe aim of this study was to evaluate the safety of 3-T MRI in patients with implanted deep brain stimulation (DBS) systems.METHODSThis study was performed in 2 phases. In an initial phantom study, a Lucite phantom filled with tissue-mimicking gel was assembled. The system was equipped with a single DBS electrode connected to an internal pulse generator. The tip of the electrode was coupled to a fiber optic thermometer with a temperature resolution of 0.1°C. Both anatomical (T1- and T2-weighted) and functional MRI sequences were tested. A temperature change within 2°C from baseline was considered safe. After findings from the phantom study suggested safety, 10 patients with implanted DBS systems targeting various brain areas provided informed consent and underwent 3-T MRI using the same imaging sequences. Detailed neurological evaluations and internal pulse generator interrogations were performed before and after imaging.RESULTSDuring phantom testing, the maximum temperature increase was registered using the T2-weighted sequence. The maximal temperature changes at the tip of the DBS electrode were < 1°C for all sequences tested. In all patients, adequate images were obtained with structural imaging, although a significant artifact from lead connectors interfered with functional imaging quality. No heating, warmth, or adverse neurological effects were observed.CONCLUSIONSTo the authors' knowledge, this was the first study to assess the clinical safety of 3-T MRI in patients with a fully implanted DBS system (electrodes, extensions, and pulse generator). It provided preliminary data that will allow further examination and assessment of the safety of 3-T imaging studies in patients with implanted DBS systems. The authors cannot advocate widespread use of this type of imaging in patients with DBS implants until more safety data are obtained.

scholarly journals Improving Accuracy for Optical Navigation in Asleep Deep Brain Stimulation Electrode Implantation

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Kim J Burchiel ◽  
Ann Mitchell ◽  
Kevin J Mansfield
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Navigation System ◽  
Entry Point ◽  
Critical Systems ◽  
Camera System ◽  
Electromagnetic System ◽  
Electromagnetic Navigation ◽  
Optical Markers ◽  
Deep Brain

Abstract INTRODUCTION The authors sought to quantify the potential error in an optically guided stereotactic neuronavigation system, and demonstrate the repercussions of this error in clinical applications. All stereotactic systems have some degree of tolerated error in their design which may exceed that presumed by the surgeon; this may produce less accurate guidance, and suboptimal surgical outcomes if not taken into account. Surgeons should maintain an understanding of the fundamental limitations of the tools they employ to maximize surgical effectiveness. METHODS A passive optical intraoperative navigation system was used to simulate an asleep deep brain stimulation (aDBS) procedure with a “frameless” targeting system (NexFrame). Multiple configurations of the targeting system components were examined to determine the sources of error. Virtual entry point and target variations were recorded and compared with points obtained using an electromagnetic navigation system and with direct measurement. RESULTS The greatest source of error was the orientation of the targeting probe to the reference frame/camera system. Virtual entry point errors ranged between 0.12 and 1.4 mm, while target errors ranged between 0.2 and 2.4 mm (mean 0.85 mm, median 0.88 mm, standard deviation 0.24 mm). These errors produced a complex, reproducible pattern based on the orientation of the targeting probe. No orientation exceeded the tolerance limits programmed into the targeting software by the manufacturer. Representative configurations were tested for physical error using the electromagnetic system; physical errors between 1.2 mm-1.4 mm + /−0.4 mm were measured and visually confirmed. CONCLUSION Use of optically guided neuronavigation is expected to expand in the future. Successful utilization of this technology depends on an understanding of the limits of the systems. When high precision is critical, systems must be optimized beyond the manufacturer's built-in tolerances. Optimal orientation of the optical markers into a plane roughly orthogonal to the line of sight from the tracking cameras is crucial to maximize accuracy.

scholarly journals Comparison between 1.5- and 3-T Magnetic Resonance Acquisitions for Direct Targeting Stereotactic Procedures for Deep Brain Stimulation: A Phantom Study

2020 ◽  
Vol 98 (5) ◽  
pp. 337-344 ◽  
Author(s):  
Gaëtan Poulen ◽  
Emilie Chan Seng ◽  
Nicolas Menjot De Champfleur ◽  
Laura Cif ◽  
Fabienne Cyprien ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Magnetic Resonance ◽  
Brain Stimulation ◽  
Phantom Study ◽  
Direct Targeting ◽  
Deep Brain

Determining the orientation angle of directional leads for deep brain stimulation using computed tomography and digital x-ray imaging: A phantom study

2017 ◽  
Vol 44 (9) ◽  
pp. 4463-4473 ◽  
Author(s):  
Alexander Sitz ◽  
Mauritius Hoevels ◽  
Alexandra Hellerbach ◽  
Andreas Gierich ◽  
Klaus Luyken ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Orientation Angle ◽  
Phantom Study ◽  
X Ray ◽  
X Ray Imaging ◽  
Deep Brain

Assessment of a method to determine deep brain stimulation targets using deterministic tractography in a navigation system

2015 ◽  
Vol 38 (4) ◽  
pp. 739-751 ◽  
Author(s):  
Josué M. Avecillas-Chasin ◽  
Fernando Alonso-Frech ◽  
Olga Parras ◽  
Nayade del Prado ◽  
Juan A. Barcia
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Navigation System ◽  
Deterministic Tractography ◽  
Deep Brain

Nicht-medikamentöse Optionen zur Behandlung pharmakoresistenter Epilepsien

2018 ◽  
Vol 75 (7) ◽  
pp. 448-454
Author(s):  
Thomas Grunwald ◽  
Judith Kröll
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Tiefe Hirnstimulation ◽  
Ketogene Diät ◽  
Deep Brain

Zusammenfassung. Wenn mit den ersten beiden anfallspräventiven Medikamenten keine Anfallsfreiheit erzielt werden konnte, so ist die Wahrscheinlichkeit, dies mit anderen Medikamenten zu erreichen, nur noch ca. 10 %. Es sollte dann geprüft werden, warum eine Pharmakoresistenz besteht und ob ein epilepsiechirurgischer Eingriff zur Anfallsfreiheit führen kann. Ist eine solche Operation nicht möglich, so können palliative Verfahren wie die Vagus-Nerv-Stimulation (VNS) und die tiefe Hirnstimulation (Deep Brain Stimulation) in eine bessere Anfallskontrolle ermöglichen. Insbesondere bei schweren kindlichen Epilepsien stellt auch die ketogene Diät eine zu erwägende Option dar.

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