title: Surgical implantation of STN-DBS leads using intraoperative MRI guidance: technique, accuracy, and clinical benefit at 1-year follow-up.
abstract: BACKGROUND
  Improvement of surgical accuracy during DBS-lead implantation has been described recently, leading to "frameless" or "MRI-verified" techniques. However, combining a high-quality definition of the STN using intraoperative 1.5 MRI with the possibility to reduce errors due to co-registration and to monitor lead progression during surgical insertion while checking the absence of surgical complication is an appealing method. We report here surgical methodology, safety, application accuracy, and clinical benefit of STN-lead implantation under MRI guidance.
  
  
  METHODS
  Two patients with a severe PD state were treated by bilateral STN-DBS. Leads were implanted under general anesthesia using intraoperative MRI guidance (ClearPoint system). Lead implantation accuracy was measured on T1 axial images at the level of the target. Clinical improvement was measured on the pre- and post-UPDRS 3 scale at 1-year follow-up.
  
  
  RESULTS
  Surgery was safe and uneventful in both cases. Radial error was 0.36 (right) and 0.86 mm (left) in case 1, and 0.41 (right) and 0.14 mm (left) in case 2. No edema or hemorrhage were noticed.
  
  
  CONCLUSIONS
  Intraoperative MRI guidance allows DBS lead implantation with high accuracy and with great clinical efficacy. A larger cohort of patients is needed to confirm these initial results.
authors: Clinique de Neurochirurgie, Pole Tête, Cou et Chirurgie Réparatrice, CHU Michallon, Grenoble, France, schabardes@chu-grenoble.fr.
authors: Stephan
authors: S
authors: Chabardes
authors: Stephanie
authors: S
authors: Isnard
authors: Anna
authors: A
authors: Castrioto
authors: Manuella
authors: M
authors: Oddoux
authors: Valerie
authors: V
authors: Fraix
authors: Lore
authors: L
authors: Carlucci
authors: Jean François
authors: JF
authors: Payen
authors: Alexandre
authors: A
authors: Krainik
authors: Paul
authors: P
authors: Krack
authors: Paul
authors: P
authors: Larson
authors: Jean François
authors: JF
authors: Le Bas
mesh_terms: D000368:Aged; D046690:Deep Brain Stimulation / Q000379:methods*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D038361:Neuronavigation / Q000379:methods*; D010300:Parkinson Disease / Q000601:surgery / Q000628:therapy; D020531:Subthalamic Nucleus / Q000502:physiology* / Q000601:surgery; D016896:Treatment Outcome