Kai Lehtimäki1, Volker A Coenen2, Antonio Gonçalves Ferreira3, Paul Boon4,5, Christian Elger6, Rod S Taylor7, Philippe Ryvlin8, Antonio Gil-Nagel9, Frans Gielen10, Thomas C Brionne11, Abdallah Abouihia11, Grégory Beth11. 1. Department of Neurosciences and Rehabilitation, Tampere University Hospital, Tampere, Finland. 2. Department of Stereotactic and Functional Neurosurgery, Freiburg University Medical Center, Freiburg, Germany. 3. Department of Neurosurgery, Hospital de Santa Maria, Lisbon, Portugal. 4. Department of Neurology, Ghent University Hospital, Ghent, Belgium. 5. Kempenhaeghe, Academic Center for Epileptology, Heeze, The Netherlands. 6. Department of Epileptology, University of Bonn, Bonn, Germany. 7. Institute of Health Research (Primary Care), University of Exeter Medical School, Exeter, United Kingdom. 8. Department of Clinical Neurosciences, Le Centre hospitalier universitaire vaudois, Lausanne, Switzerland. 9. Department of Neurology, Hospital Ruber Internacional, Madrid, Spain. 10. Medtronic Bakken Research Center, Maastricht, The Netherlands. 11. Medtronic International Trading Sarl, Tolochenaz, Switzerland.
Abstract
BACKGROUND: The Medtronic Registry for Epilepsy (MORE; Medtronic Inc, Dublin, Ireland) is an open label observational study evaluating the long-term effectiveness, safety, and performance of deep brain stimulation (DBS) of the anterior nucleus of thalamus (ANT) for the treatment of refractory epilepsy. OBJECTIVE: To compare the difference in success rate of placing contacts at ANT-target region (ANT-TR) between transventricular (TV) and extraventricular (EV) lead trajectories in 73 ANT-DBS implants in 17 European centers participating in the MORE registry. METHODS: The success rate of placing contacts at ANT-TR was evaluated using a screening method combining both individual patient imaging information and stereotactic atlas information to identify contacts at ANT-TR. RESULTS: EV lead trajectory was used in 53% of the trajectories. Approximately, 90% of the TV lead trajectories had at least 1 contact at ANT-TR, vs only 71% of the EV lead trajectories. The success rate for placing at least 1 contact at ANT-TR bilaterally was 84% for TV implants and 58% for EV implants (P < .05; Fisher's exact). No intracranial bleedings were observed, but 1 cortical infarct was reported following EV lead trajectory. CONCLUSION: The results of this registry support the use of TV lead trajectories for ANT-DBS as they have a higher probability in placing contacts at ANT-TR, without appearing to compromise procedural safety. Follow-up data collection is continuing in the MORE registry. These data will provide outcomes associated with TV and EV trajectories.
BACKGROUND: The Medtronic Registry for Epilepsy (MORE; Medtronic Inc, Dublin, Ireland) is an open label observational study evaluating the long-term effectiveness, safety, and performance of deep brain stimulation (DBS) of the anterior nucleus of thalamus (ANT) for the treatment of refractory epilepsy. OBJECTIVE: To compare the difference in success rate of placing contacts at ANT-target region (ANT-TR) between transventricular (TV) and extraventricular (EV) lead trajectories in 73 ANT-DBS implants in 17 European centers participating in the MORE registry. METHODS: The success rate of placing contacts at ANT-TR was evaluated using a screening method combining both individual patient imaging information and stereotactic atlas information to identify contacts at ANT-TR. RESULTS:EV lead trajectory was used in 53% of the trajectories. Approximately, 90% of the TV lead trajectories had at least 1 contact at ANT-TR, vs only 71% of the EV lead trajectories. The success rate for placing at least 1 contact at ANT-TR bilaterally was 84% for TV implants and 58% for EV implants (P < .05; Fisher's exact). No intracranial bleedings were observed, but 1 cortical infarct was reported following EV lead trajectory. CONCLUSION: The results of this registry support the use of TV lead trajectories for ANT-DBS as they have a higher probability in placing contacts at ANT-TR, without appearing to compromise procedural safety. Follow-up data collection is continuing in the MORE registry. These data will provide outcomes associated with TV and EV trajectories.
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