The first evaluation of brain shift during functional neurosurgery by deformation field analysis.
Stereotactic surgery is based on a high degree of accuracy in defining and localising intracranial targets and placing surgical tools. Brain shift can influence its accuracy significantly. Deep brain stimulation of the subthalamic nucleus can markedly change the quality of life of patients with advanced Parkinson's disease, but the outcome depends on the quality of electrode placement. A patient is reported in whom the placement of the second electrode was not successful. Deformation field analysis of pre- and postoperative three dimensional magnetic resonance images showed an intraoperative brain movement of 2 mm in the region of the subthalamic nucleus (the target point). Electrode repositioning resulted in efficient stimulation effects. This case report shows the need to reduce risk factors for intraoperative brain movement and demonstrates the ability of deformation field analysis to quantify this complication.
Winkler
D
D
Department of Neurosurgery, University of Leipzig, Leipzig, Germany. wind@medizin.uni-leipzig.de
Tittgemeyer
M
M
Schwarz
J
J
Preul
C
C
Strecker
K
K
Meixensberger
J
J
D000368:Aged; D000978:Antiparkinson Agents / Q000009:adverse effects; D046690:Deep Brain Stimulation / Q000295:instrumentation*; D020820:Dyskinesias / Q000209:etiology; D004567:Electrodes, Implanted; D005684:Gait; D006801:Humans; D021621:Imaging, Three-Dimensional; D007430:Intraoperative Care; D007980:Levodopa / Q000009:adverse effects; D008279:Magnetic Resonance Imaging / Q000295:instrumentation*; D008297:Male; D008839:Microelectrodes; D009069:Movement Disorders / Q000209:etiology; D019635:Neurosurgical Procedures / Q000379:methods*; D010300:Parkinson Disease / Q000150:complications / Q000188:drug therapy / Q000601:surgery*; D011605:Psychoses, Substance-Induced / Q000209:etiology; D016634:Radiosurgery / Q000295:instrumentation*; D020531:Subthalamic Nucleus / Q000601:surgery*
D000978:Antiparkinson Agents; D007980:Levodopa