title: Visualization of small veins with susceptibility-weighted imaging for stereotactic trajectory planning in deep brain stimulation.
abstract: Intracerebral hemorrhage (ICH) is the most significant complication of Deep Brain Stimulation (DBS). To prevent ICH, stereotactic contrast enhanced T1-weighted images are used to visualize vessels as source of hemorrhage. Susceptibility-Weighted Imaging (SWI) is an MRI sequence with improved visualization of susceptibility differences between tissues, particularly sensitive for brain veins. The aim of this prospective study was to analyze the utility of SWI compared to contrast enhanced stereotactic T1-weighted images for trajectory planning of DBS. Preoperative SWI was performed in 33 patients undergoing DBS and was compared to the T1-weighted images. Vessels identified only with SWI in relation to the bilateral planned trajectory were analyzed. In all patients vessels were depicted on SWI only within the planned trajectory (range 1-4 vessels, for each trajectory, mean: 2.4). In 6 patients vessels were identified on SWI adjacent to the target (up to 5mm distal from target). In 11 patients SWI visualized additional cortical veins adjacent to the entry point of the trajectory. The apparent diameter of these vessels ranged between 0.8 and 2.1mm (mean: 1.2mm). Postoperative MRI was compared with preoperative SWI and revealed in two patients small (<3 mm) T2 hyperintense lesions along electrodes without correlation with visualized veins. SWI facilitates the visualization of small veins superior to T1-weighted images. However, cerebral veins within the trajectory were not found to be a significant source of ICH after DBS. Potential sources of ICH are mesencephal veins at the endpoint of electrodes which can cause fatal hemorrhage and are visualized with SWI reliably.
authors: Department of Neurosurgery, Clinic of Köln-Merheim, University of Witten-Herdecke, Köln, Germany. Electronic address: mmahvash@yahoo.de.
authors: Mehran
authors: M
authors: Mahvash
authors: Department of Neurosurgery, Clinic of Köln-Merheim, University of Witten-Herdecke, Köln, Germany.
authors: Ioannis
authors: I
authors: Pechlivanis
authors: Department of Neurosurgery, Clinic of Köln-Merheim, University of Witten-Herdecke, Köln, Germany.
authors: Patra
authors: P
authors: Charalampaki
authors: Institute of Neuroradiology, University Hospitals of Schleswig-Holstein, Campus Kiel, Germany.
authors: Olav
authors: O
authors: Jansen
authors: Department of Neurosurgery, University Hospitals of Schleswig-Holstein, Campus Kiel, Germany.
authors: Hubertus Maximilian
authors: HM
authors: Mehdorn
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002543:Cerebral Hemorrhage / Q000517:prevention & control*; D002550:Cerebral Veins / Q000473:pathology*; D046690:Deep Brain Stimulation / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D013238:Stereotaxic Techniques; D055815:Young Adult
keywords: Deep Brain Stimulation; Intracerebral hemorrhage; Susceptibility Weighted Imaging; Veins