Placement of deep brain stimulator electrodes using real-time high-field interventional magnetic resonance imaging.
A methodology is presented for placing deep brain stimulator electrodes under direct MR image guidance. The technique utilized a small, skull-mounted trajectory guide that is optimized for accurate alignment under MR fluoroscopy. Iterative confirmation scans are used to monitor device alignment and brain penetration. The methodology was initially tested in a human skull phantom and proved capable of achieving submillimeter accuracy over a set of 16 separate targets that were accessed. The maximum error that was obtained in this preliminary test was 2 mm, motivating use of the technique in a clinical study. Subsequently, a total of eight deep brain stimulation electrodes were placed in five patients. Satisfactory placement was achieved on the first pass in seven of eight electrodes, while two passes were required with one electrode. Mean error from the intended target on the first pass was 1.0 +/- 0.8 mm (range = 0.1-1.9 mm). All procedures were considered technical successes and there were no intraoperative complications; however, one patient did develop a postoperative infection.
Martin
Alastair J
AJ
Department of Radiology, University of California, San Francisco, California 94143, USA. Alastair.Martin@radiology.ucsf.edu
Larson
Paul S
PS
Ostrem
Jill L
JL
Keith Sootsman
W
W
Talke
Pekka
P
Weber
Oliver M
OM
Levesque
Nadja
N
Myers
Jeffrey
J
Starr
Philip A
PA
D001921:Brain / Q000473:pathology* / Q000601:surgery; D003199:Computer Systems; D046690:Deep Brain Stimulation / Q000295:instrumentation / Q000379:methods*; D004567:Electrodes, Implanted; D004574:Electromagnetic Fields; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D007090:Image Interpretation, Computer-Assisted / Q000379:methods; D008279:Magnetic Resonance Imaging / Q000379:methods*; D019047:Phantoms, Imaging; D019919:Prosthesis Implantation / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D025321:Surgery, Computer-Assisted / Q000379:methods*