title: The effect of intraventricular trajectory on brain shift in deep brain stimulation.
abstract: BACKGROUND
  Brain shift during deep brain stimulation (DBS) surgery may compromise target localization. Loss of cerebrospinal fluid is believed to be the underlying mechanism, thus an intraventricular trajectory during DBS surgery may be associated with increased shift, in addition to other complications, such as intraventricular hemorrhage.
  
  
  OBJECTIVE
  We set out to assess the effect of traversing the lateral ventricle on brain shift during DBS surgery.
  
  
  METHODS
  We performed a retrospective review of 65 pre- and postoperative MR images of patients who underwent bilateral subthalamic nucleus deep brain stimulator placement to treat advanced Parkinson's disease. Patients were separated into two groups: Group A (intraventricular trajectory, n = 46) and Group B (no intraventricular trajectory, n = 19). In these patients, we compared pre- and postoperative frame coordinates of the red nucleus (RN).
  
  
  RESULTS
  Group B demonstrated significantly more posterior shift of the center of the RN (1.40 ± 1.32 mm) than Group A (0.64 ± 1.76 mm; p < 0.02). We found no increase in incidence of intraventricular hemorrhage or the number of microelectrode trajectory attempts.
  
  
  CONCLUSIONS
  Intraventricular trajectories during DBS surgery do not appear to compromise safety or targeting accuracy.
authors.affiliation: University of Pennsylvania, Center for Functional and Restorative Neurosurgery, Pennsylvania Hospital, Philadelphia, PA 19106, USA.
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Kramer
authors.forename: Casey H
authors.initials: CH
authors.lastname: Halpern
authors.forename: Shabbar F
authors.initials: SF
authors.lastname: Danish
authors.forename: Jurg L
authors.initials: JL
authors.lastname: Jaggi
authors.forename: Gordon H
authors.initials: GH
authors.lastname: Baltuch
mesh_terms: D000368:Aged; D046690:Deep Brain Stimulation / Q000009:adverse effects* / Q000379:methods*; D005260:Female; D006801:Humans; D015994:Incidence; D020300:Intracranial Hemorrhages / Q000453:epidemiology / Q000209:etiology; D008279:Magnetic Resonance Imaging; D008297:Male; D008839:Microelectrodes; D008875:Middle Aged; D010300:Parkinson Disease / Q000473:pathology / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome