Simulation to locate burr hole sites in a patient for deep brain stimulation surgery and clipping of intracranial aneurysm.
OBJECTIVE
Deep brain stimulation (DBS) candidates with neurologic diseases such as unruptured aneurysm present additional challenges to neurosurgeons when craniotomy must precede DBS surgery. Such craniotomy may potentially overlap with intended burr hole sites for the later insertion of DBS electrodes, and the skin incision for craniotomy may lie very close to or intersect with that for the burr holes. We report here a case of forehead craniotomy prior to DBS surgery in which we employed a neuronavigation system to simulate locations for the craniotomy and burr holes.


METHODS
A 62-year-old male patient with Parkinson's disease was a candidate for DBS. He also had an aneurysm and was planned first to undergo frontal craniotomy for clipping before the DBS surgery. The locations of the craniotomy, burr holes, and skin incisions were therefore simulated using a neuronavigation system during craniotomy.


RESULTS
Two weeks after the craniotomy, the patient underwent DBS surgery. Planning software confirmed the absence of cortical veins beneath the entry points of tentative burr holes and aided trajectory planning. The DBS surgery was performed without the interference of the burr holes and head pins and the craniotomy.


CONCLUSIONS
Simulation of the locations of craniotomy and burr holes using a neuronavigation system proved valuable in the present case of frontal craniotomy before DBS surgery.
Division of Applied System Neuroscience, Department of Advanced Medical Science, Nihon University School of Medicine, Tokyo, Japan.
Kazutaka
K
Kobayashi
Suguru
S
Nakamura
Mitsuru
M
Watanabe
Kentaro
K
Shimoda
Takashi
T
Morishita
Koichiro
K
Sumi
Toshiharu
T
Otaka
Toshiki
T
Obuchi
Katsunori
K
Shijyo
Toshikazu
T
Kano
Hideki
H
Oshima
Chikashi
C
Fukaya
Takamitsu
T
Yamamoto
Yoichi
Y
Katayama
D002533:Cerebral Angiography; D003399:Craniotomy / Q000379:methods*; D046690:Deep Brain Stimulation; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D038361:Neuronavigation; D010300:Parkinson Disease / Q000150:complications / Q000628:therapy; D013525:Surgical Instruments