title: The pros and cons of intraoperative CT scan in evaluation of deep brain stimulation lead implantation: A retrospective study.
abstract: BACKGROUND
  Deep brain stimulation (DBS) is an established therapy for movement disorders, such as Parkinson's disease (PD), dystonia, and tremor. The efficacy of DBS depends on the correct lead positioning. The commonly adopted postoperative radiological evaluation is performed with computed tomography (CT) scan and/or magnetic resonance imaging (MRI).
  
  
  METHODS
  We conducted a retrospective study on 202 patients who underwent DBS from January 2009 to October 2013. DBS indications were PD, progressive supranuclear palsy, tremor, dystonia, Tourette syndrome, obsessive compulsive disorder, depression, and Huntington's disease. Preoperatively, all patients underwent brain MRI and brain CT scan with the stereotactic frame positioned. The lead location was confirmed intraoperatively with CT. The CT images were subsequently transferred to the Stealth Station Medtronic and merged with the preoperative planning. On the first or second day after, implantation we performed a brain MRI to confirm the correct position of the lead.
  
  
  RESULTS
  In 14 patients, leads were in suboptimal position after intraoperative CT scan positioning. The cases with alteration in the Z-axis were corrected immediately under fluoroscopic guidance. In all the 14 patients, an immediate repositioning was done.
  
  
  CONCLUSIONS
  Based on our data, intraoperative CT scan is fast, safe, and a useful tool in the evaluation of the position of the implanted lead. It also reduces the patient's discomfort derived from the transfer of the patient from the operating room to the radiological department. However, intraoperative CT should not be considered as a substitute for postoperative MRI.
authors: Department of Neurology and Neurosurgery, IRCCS Galeazzi, Milan, Italy.
authors: Domenico
authors: D
authors: Servello
authors: Department of Neurology and Neurosurgery, IRCCS Galeazzi, Milan, Italy.
authors: Edvin
authors: E
authors: Zekaj
authors: Department of Neurology and Neurosurgery, IRCCS Galeazzi, Milan, Italy.
authors: Christian
authors: C
authors: Saleh
authors: Department of Neurology and Neurosurgery, IRCCS Galeazzi, Milan, Italy.
authors: Claudio
authors: C
authors: Pacchetti
authors: Department of Neurology and Neurosurgery, IRCCS Galeazzi, Milan, Italy.
authors: Mauro
authors: M
authors: Porta
keywords: Accuracy; O-Arm; computed tomography; deep brain stimulation; imaging; magnetic resonance imaging; targets