Accuracy of Intraoperative Computed Tomography during Deep Brain Stimulation Procedures: Comparison with Postoperative Magnetic Resonance Imaging

Abstract

Objective: To determine the accuracy of intraoperative computed tomography (iCT) in localizing deep brain stimulation (DBS) electrodes by comparing this modality with postoperative magnetic resonance imaging (MRI). Background: Optimal lead placement is a critical factor for the outcome of DBS procedures and preferably confirmed during surgery. iCT offers 3-dimensional verification of both microelectrode and lead location during DBS surgery. However, accurate electrode representation on iCT has not been extensively studied. Methods: DBS surgery was performed using the Leksell stereotactic G frame. Stereotactic coordinates of 52 DBS leads were determined on both iCT and postoperative MRI and compared with intended final target coordinates. The resulting absolute differences in X (medial-lateral), Y (anterior-posterior), and Z (dorsal-ventral) coordinates (ΔX, ΔY, and ΔZ) for both modalities were then used to calculate the euclidean distance. Results: Euclidean distances were 2.7 ± 1.1 and 2.5 ± 1.2 mm for MRI and iCT, respectively (p = 0.2). Conclusion: Postoperative MRI and iCT show equivalent DBS lead representation. Intraoperative localization of both microelectrode and DBS lead in stereotactic space enables direct adjustments. Verification of lead placement with postoperative MRI, considered to be the gold standard, is unnecessary.

Comparison of Awake and Asleep Deep Brain Stimulation for Parkinson’s Disease: A Detailed Analysis Through Literature Review

“…Some centers utilize intraoperative computed tomography (iCT) to verify accuracy of lead placement. This is done through the fusion of the iCT scan with the preoperative MRI scan after intracranial electrode implantation . Meanwhile, other centers use an interventional MRI (iMRI) to guide placement of DBS electrodes .…”

“…The modality of intraoperative image verification of lead accuracy makes a difference. For example, target confirmation through fusion with an iCT scan in asleep DBS surgery appears to shorten the duration of surgery . While there are few published research studies using intraoperative MRI , one reported advantage is that the intraoperative (or interventional) MRI (iMRI) approach uses near real‐time acquisition of images to prospectively guide both trajectory planning and the intended targets verification before electrode placement .…”

Bilateral Subthalamic Nucleus Deep Brain Stimulation under General Anesthesia: Literature Review and Single Center Experience

“…In some centers, intraoperative computed tomography (iCT) during surgery is used to verify the accuracy of lead placement (Table 1). This is achieved through fusion of iCT scans and preoperative MRI scans after intracranial electrode implantation [31,37,41,44,47]. In awake DBS surgery with MER guidance, iCT provides useful information, such as hemorrhage and a general idea of electrode location when fused with preoperative MRI [21].…”

Insights into the Molecular Mechanisms of Alzheimer’s and Parkinson’s Diseases with Molecular Simulations: Understanding the Roles of Artificial and Pathological Missense Mutations in Intrinsically Disordered Proteins Related to Pathology

“…Currently, there are two surgical treatments available for people living with PD—deep brain stimulation (DBS) and surgery performed to insert a tube in the small intestine, which delivers a gel formulation of carbidopa/levodopa (Duopa™) [ 74 , 75 , 76 , 77 ]. In DBS, surgery is performed to insert electrodes into a targeted area of the brain, using MRI and recordings of brain cell activity during the procedure.…”