Longitudinal Assessment of Rotation Angles after Implantation of Directional Deep Brain Stimulation Leads
| Autor: | Doortje Engel, Cordula Matthies, Tilmann Neun, Jens Volkmann, Frank Steigerwald, Patrick Fricke, Philipp Capetian, Tobias Malzacher, Florian Lange |
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| Rok vydání: | 2020 |
| Předmět: |
Deep brain stimulation
business.industry Deep Brain Stimulation medicine.medical_treatment Skull Neuroimaging Stimulation Rotation Lateralization of brain function 030218 nuclear medicine & medical imaging 03 medical and health sciences 0302 clinical medicine Orientation (geometry) Humans Medicine Surgery Neurology (clinical) Time point Artifacts business Lead (electronics) 030217 neurology & neurosurgery Retrospective Studies Biomedical engineering |
| Zdroj: | Stereotactic and Functional Neurosurgery. 99:150-158 |
| ISSN: | 1423-0372 1011-6125 |
| DOI: | 10.1159/000511202 |
| Popis: | Purpose: The risk/benefit-ratio of deep brain stimulation (DBS) depends on focusing the electrical field onto the target volume, excluding side-effect eliciting structures. Directional leads limiting radial current diffusion can target stimulation but add a spatial degree of freedom that requires control to align multimodal imaging datasets and for anatomical interpretation of stimulation. Unpredictable postoperative lead rotations have been reported. The extent and timing of rotation from the surgically intended alignment remain uncertain, as does the time point at which directional stimulation can be safely initiated without risking unexpected shifts in stimulation volume. We present a retrospective analysis of clinically indicated, repeated neuroimaging controls postimplantation in patients with directional DBS systems, which allow estimation of the amount and timing of postoperative lead rotation. Methods: Data from 67 patients with directional leads and multiple cranial computer tomographies (CCT) and/or rotation fluoroscopies at different postoperative time points were included. Rotation angles were detected based on CCT artifacts (n = 56) or direct visualization of lead segments on rotation fluoroscopies (n = 52). Cross-validation of both methods was conducted in patients who received both imaging modalities (n = 51). Results: Rotation angles deviated significantly (∼30°) from their intended 0° anterior/posterior orientation. Rotation was firmly established within the first postoperative day, with no additional torque in subsequent scans. The two methods highly correlated (right hemisphere: R2 = 0.94, left hemisphere: R2 = 0.91). Conclusion: Both methods for measuring rotation angles led to comparable results and can be used interchangeably. Directional stimulation settings can safely be initiated after the first postoperative day, without risking subsequent lead rotation-related anatomical shifts. |
| Databáze: | OpenAIRE |
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