title: Perioperative brain shift and deep brain stimulating electrode deformation analysis: implications for rigid and non-rigid devices.
abstract: Deep brain stimulation (DBS) efficacy is related to optimal electrode placement. Several authors have quantified brain shift related to surgical targeting; yet, few reports document and discuss the effects of brain shift after insertion.
  
  
  OBJECTIVE
  To quantify brain shift and electrode displacement after device insertion. Twelve patients were retrospectively reviewed, and one post-operative MRI and one time-delayed CT were obtained for each patient and their implanted electrodes modeled in 3D. Two competing methods were employed to measure the electrode tip location and deviation from the prototypical linear implant after the resolution of acute surgical changes, such as brain shift and pneumocephalus. In the interim between surgery and a pneumocephalus free postoperative scan, electrode deviation was documented in all patients and all electrodes. Significant shift of the electrode tip was identified in rostral, anterior, and medial directions (p < 0.05). Shift was greatest in the rostral direction, measuring an average of 1.41 mm. Brain shift and subsequent electrode displacement occurs in patients after DBS surgery with the reversal of intraoperative brain shift. Rostral displacement is on the order of the height of one DBS contact. Further investigation into the time course of intraoperative brain shift and its potential effects on procedures performed with rigid and non-rigid devices in supine and semi-sitting surgical positions is needed.
authors.affiliation: Department of Neurological Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA. sillay@neurosurgery.wisc.edu
authors.forename: Karl A
authors.initials: KA
authors.lastname: Sillay
authors.forename: L M
authors.initials: LM
authors.lastname: Kumbier
authors.forename: C
authors.initials: C
authors.lastname: Ross
authors.forename: M
authors.initials: M
authors.lastname: Brady
authors.forename: A
authors.initials: A
authors.lastname: Alexander
authors.forename: A
authors.initials: A
authors.lastname: Gupta
authors.forename: N
authors.initials: N
authors.lastname: Adluru
authors.forename: G S
authors.initials: GS
authors.lastname: Miranpuri
authors.forename: J C
authors.initials: JC
authors.lastname: Williams
mesh_terms: D000368:Aged; D001921:Brain / Q000000981:diagnostic imaging / Q000503:physiopathology; D046690:Deep Brain Stimulation / Q000295:instrumentation* / Q000379:methods; D004567:Electrodes, Implanted; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000295:instrumentation* / Q000379:methods; D009069:Movement Disorders / Q000628:therapy; D014057:Tomography, X-Ray Computed