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.
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.
Authors: Robert Fisher; Vicenta Salanova; Thomas Witt; Robert Worth; Thomas Henry; Robert Gross; Kalarickal Oommen; Ivan Osorio; Jules Nazzaro; Douglas Labar; Michael Kaplitt; Michael Sperling; Evan Sandok; John Neal; Adrian Handforth; John Stern; Antonio DeSalles; Steve Chung; Andrew Shetter; Donna Bergen; Roy Bakay; Jaimie Henderson; Jacqueline French; Gordon Baltuch; William Rosenfeld; Andrew Youkilis; William Marks; Paul Garcia; Nicolas Barbaro; Nathan Fountain; Carl Bazil; Robert Goodman; Guy McKhann; K Babu Krishnamurthy; Steven Papavassiliou; Charles Epstein; John Pollard; Lisa Tonder; Joan Grebin; Robert Coffey; Nina Graves Journal: Epilepsia Date: 2010-03-17 Impact factor: 5.864
Authors: Chelsea S Kidwell; Julio A Chalela; Jeffrey L Saver; Sidney Starkman; Michael D Hill; Andrew M Demchuk; John A Butman; Nicholas Patronas; Jeffry R Alger; Lawrence L Latour; Marie L Luby; Alison E Baird; Megan C Leary; Margaret Tremwel; Bruce Ovbiagele; Andre Fredieu; Shuichi Suzuki; J Pablo Villablanca; Stephen Davis; Billy Dunn; Jason W Todd; Mustapha A Ezzeddine; Joseph Haymore; John K Lynch; Lisa Davis; Steven Warach Journal: JAMA Date: 2004-10-20 Impact factor: 56.272
Authors: Jörg Spiegel; Gerhard Fuss; Martin Backens; Wolfgang Reith; Tim Magnus; Georg Becker; Jean-Richard Moringlane; Ulrich Dillmann Journal: J Neurosurg Date: 2003-10 Impact factor: 5.115
Authors: Jochen B Fiebach; Peter D Schellinger; Achim Gass; Thomas Kucinski; Mario Siebler; Arno Villringer; Peter Olkers; Jochen G Hirsch; Sabine Heiland; Philipp Wilde; Olav Jansen; Joachim Röther; Werner Hacke; Klaus Sartor Journal: Stroke Date: 2004-01-22 Impact factor: 7.914
Authors: Michael R Gionfriddo; Alexandra J Greenberg; Abhijeet L Wahegaonkar; Kendall H Lee Journal: Clin Transl Sci Date: 2013-04-19 Impact factor: 4.689