Philipp Krauss1, Christiaan Hendrik Bas Van Niftrik2,3, Giovanni Muscas3,4, Pierre Scheffler2,3, Markus Florian Oertel2,3, Lennart Henning Stieglitz2,3. 1. Department of Neurosurgery, Klinikum rechts der Isar, Ismaninger Strasse 22, 81675, Munich, Germany. ph.krauss@gmx.de. 2. Department of Neurosurgery, University Hospital of Zurich, Zurich, Switzerland. 3. Clinical Neuroscience Center, University Hospital of Zurich, Zurich, Switzerland. 4. Department of Neurosurgery, Careggi University Hospital Florence, Florence, Italy.
Abstract
BACKGROUND: Accuracy of lead placement is the key to success in deep brain stimulation (DBS). Precise anatomic stereotactic planning usually is based on stable perioperative anatomy. Pneumocephalus due to intraoperative CSF loss is a common procedure-related phenomenon which could lead to brain shift and targeting inaccuracy. The aim of this study was to evaluate potential risk factors of pneumocephalus in DBS surgery. METHODS: We performed a retrospective single-center analysis in patients undergoing bilateral DBS. We quantified the amount of pneumocephalus by postoperative CT scans and corrected the data for accompanying brain atrophy by an MRI-based score. Automated computerized segmentation algorithms from a dedicated software were used. As potential risk factors, we evaluated the impact of trephination size, the number of electrode tracks, length of surgery, intraoperative blood pressure, and brain atrophy. RESULTS: We included 100 consecutive patients that underwent awake DBS with intraoperative neurophysiological testing. Systolic and mean arterial blood pressure showed a substantial impact with an inverse correlation, indicating that lower blood pressure is associated with higher volume of pneumocephalus. Furthermore, the length of surgery was clearly correlated to pneumocephalus. CONCLUSION: Our analysis identifies intraoperative systolic and mean arterial blood pressure as important risk factors for pneumocephalus in awake stereotactic surgery.
BACKGROUND: Accuracy of lead placement is the key to success in deep brain stimulation (DBS). Precise anatomic stereotactic planning usually is based on stable perioperative anatomy. Pneumocephalus due to intraoperative CSF loss is a common procedure-related phenomenon which could lead to brain shift and targeting inaccuracy. The aim of this study was to evaluate potential risk factors of pneumocephalus in DBS surgery. METHODS: We performed a retrospective single-center analysis in patients undergoing bilateral DBS. We quantified the amount of pneumocephalus by postoperative CT scans and corrected the data for accompanying brain atrophy by an MRI-based score. Automated computerized segmentation algorithms from a dedicated software were used. As potential risk factors, we evaluated the impact of trephination size, the number of electrode tracks, length of surgery, intraoperative blood pressure, and brain atrophy. RESULTS: We included 100 consecutive patients that underwent awake DBS with intraoperative neurophysiological testing. Systolic and mean arterial blood pressure showed a substantial impact with an inverse correlation, indicating that lower blood pressure is associated with higher volume of pneumocephalus. Furthermore, the length of surgery was clearly correlated to pneumocephalus. CONCLUSION: Our analysis identifies intraoperative systolic and mean arterial blood pressure as important risk factors for pneumocephalus in awake stereotactic surgery.
Authors: Günther Deuschl; Carmen Schade-Brittinger; Paul Krack; Jens Volkmann; Helmut Schäfer; Kai Bötzel; Christine Daniels; Angela Deutschländer; Ulrich Dillmann; Wilhelm Eisner; Doreen Gruber; Wolfgang Hamel; Jan Herzog; Rüdiger Hilker; Stephan Klebe; Manja Kloss; Jan Koy; Martin Krause; Andreas Kupsch; Delia Lorenz; Stefan Lorenzl; H Maximilian Mehdorn; Jean Richard Moringlane; Wolfgang Oertel; Marcus O Pinsker; Heinz Reichmann; Alexander Reuss; Gerd-Helge Schneider; Alfons Schnitzler; Ulrich Steude; Volker Sturm; Lars Timmermann; Volker Tronnier; Thomas Trottenberg; Lars Wojtecki; Elisabeth Wolf; Werner Poewe; Jürgen Voges Journal: N Engl J Med Date: 2006-08-31 Impact factor: 91.245
Authors: Bruce Fischl; David H Salat; André J W van der Kouwe; Nikos Makris; Florent Ségonne; Brian T Quinn; Anders M Dale Journal: Neuroimage Date: 2004 Impact factor: 6.556