title: Transcranial sonographic localization of deep brain stimulation electrodes is safe, reliable and predicts clinical outcome.
abstract: In patients with deep brain stimulation (DBS), poor postoperative outcome or unexpected clinical change require brain imaging to check the lead location. Here, we studied safety, reliability and prognostic value of transcranial sonography (TCS) for DBS lead localization applying predefined TCS criteria. After measuring thermal effects of TCS and imaging artefact sizes of DBS lead using a skull phantom, we prospectively enrolled 34 patients with DBS of globus pallidus internus, ventro-intermediate thalamic or subthalamic nucleus. TCS had no influence on lead temperature, electrical parameters of DBS device or clinical state of patients. TCS measures of lead coordinates agreed with MRI measures in anterior-posterior and medial-lateral axis. Lead dislocation requiring reinsertion was reliably detected. Only patients with optimal lead position on TCS had favorable clinical 12-month outcome (>50% improvement), whereas unfavorable outcome (<25% improvement) was associated with suboptimal lead position. TCS may therefore become a first-choice modality to monitor lead location.
authors.affiliation: Department of Neurology, University of Rostock, Rostock, Germany. uwe.walter@med.uni-rostock.de
authors.forename: Uwe
authors.initials: U
authors.lastname: Walter
authors.forename: Michael
authors.initials: M
authors.lastname: Kirsch
authors.forename: Matthias
authors.initials: M
authors.lastname: Wittstock
authors.forename: Jan-Uwe
authors.initials: JU
authors.lastname: Müller
authors.forename: Reiner
authors.initials: R
authors.lastname: Benecke
authors.forename: Alexander
authors.initials: A
authors.lastname: Wolters
mesh_terms: D000368:Aged; D016477:Artifacts; D046690:Deep Brain Stimulation / Q000295:instrumentation*; D004421:Dystonia / Q000000981:diagnostic imaging / Q000628:therapy*; D004868:Equipment Failure; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019047:Phantoms, Imaging; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D015203:Reproducibility of Results; D018709:Statistics, Nonparametric; D014057:Tomography, X-Ray Computed; D017585:Ultrasonography, Doppler, Transcranial / Q000379:methods*