Comparison of Deep Brain Stimulation Lead Targeting Accuracy and Procedure Duration between 1.5- and 3-Tesla Interventional Magnetic Resonance Imaging Systems: An Initial 12-Month Experience

Southwell, Derek G.; Narvid, Jared; Martin, Alastair J.; Qasim, Salman E.; Starr, Philip A.; Larson, Paul

doi:10.1159/000443407

Cited by 23 publications

(9 citation statements)

References 15 publications

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“…Furthermore, the increased error in our MER group for the right lead suggests that greater brain shift occurs over the course of the surgical case, as the left lead was always placed first. Our iMRI accuracy was similar to other iMRI studies ( 10 , 38 , 39 ), and was superior to results for CT-based verification approaches, which report mean errors of approximately 1.2 mm (SD = 0.7 mm) ( 11 , 12 ). The greater accuracy of iMRI is likely a product of prospective stereotaxy, as unlike CT-based approaches, the trajectory can be adjusted prior to placement to account for brain shift.…”

Section: Discussionsupporting

confidence: 85%

Outcomes of Interventional-MRI Versus Microelectrode Recording-Guided Subthalamic Deep Brain Stimulation

et al. 2018

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In deep brain stimulation (DBS) of the subthalamic nucleus (STN) for Parkinson’s disease (PD), there is debate concerning the use of neuroimaging alone to confirm correct anatomic placement of the DBS lead into the STN, versus the use of microelectrode recording (MER) to confirm functional placement. We performed a retrospective study of a contemporaneous cohort of 45 consecutive patients who underwent either interventional-MRI (iMRI) or MER-guided DBS lead implantation. We compared radial lead error, motor and sensory side effect, and clinical benefit programming thresholds, and pre- and post-operative unified PD rating scale scores, and levodopa equivalent dosages. MER-guided surgery was associated with greater radial error compared to the intended target. In general, side effect thresholds during initial programming were slightly lower in the MER group, but clinical benefit thresholds were similar. No significant difference in the reduction of clinical symptoms or medication dosage was observed. In summary, iMRI lead implantation occurred with greater anatomic accuracy, in locations demonstrated to be the appropriate functional region of the STN, based on the observation of similar programming side effect and benefit thresholds obtained with MER. The production of equivalent clinical outcomes suggests that surgeon and patient preference can be used to guide the decision of whether to recommend iMRI or MER-guided DBS lead implantation to appropriate patients with PD.

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Section: Discussionsupporting

confidence: 85%

Outcomes of Interventional-MRI Versus Microelectrode Recording-Guided Subthalamic Deep Brain Stimulation

et al. 2018

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“…The main difference between asleep and awake DBS surgery is the method of intraoperatively verifying the position of electrode implantation. Some neurosurgical centers have performed asleep DBS surgery under GA with iMRI 4 , 8 , 9 or iCT merged together with preoperative MRI to verify the accuracy of electrode implantation 10 , 11 . It has been demonstrated that the clinical outcomes and complication rates of asleep surgery are comparable to those in historical studies using MER to guide or confirm lead placement under LA 12 – 15 .…”

Section: Discussionmentioning

confidence: 99%

“…To date, awake surgery has been typically performed with intraoperative test stimulations 3 . Recently, asleep surgery has been performed under general anesthesia (GA) with intraoperative magnetic resonance imaging (iMRI) 4 or computed tomography (iCT) 5 to confirm the position of the electrode tip. However, limited research and clinical experience has been reported regarding robot-assisted asleep surgery.…”

Section: Deep Brain Stimulation (Dbs) Surgery Is An Effective Treatmementioning

confidence: 99%

A comparative study of asleep and awake deep brain stimulation robot-assisted surgery for Parkinson’s disease

Jin

Gong

Tao

et al. 2020

npj Parkinsons Dis.

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To compare the differences between asleep and awake robot-assisted deep brain stimulation (DBS) surgery for Parkinson’s Disease (PD), we conducted this retrospective cohort study included 153 PD patients undergoing bilateral robot-assisted DBS from June 2017 to August 2019, of which 58 cases were performed under general anesthesia (GA) and 95 cases under local anesthesia (LA). Procedure duration, stimulation parameters, electrode implantation accuracy, intracranial air, intraoperative electrophysiological signal length, complications, and Unified PD Rating Scale (UPDRS) measurements were recorded and compared. The clinical evaluation was conducted by two raters who were blinded to the choice of anesthesia. Procedure duration was significantly shorter in the GA group, while on stimulation off medication motor scores (UPDRS-III) were significantly improved in both the GA and LA group. ANCOVA covariated for the baseline UPDRS-III and levodopa challenge exhibited no significant differences. In terms of amplitude, frequency, and pulse width, the stimulation parameters used for DBS power-on were similar. There were no significant differences in electrode implantation accuracy, intraoperative electrophysiological signal length, or intracerebral hemorrhage (no occurrences in either group). The pneumocephalus volume was significantly smaller in the GA group. Six patients exhibited transient throat discomfort associated with tracheal intubation in the GA group. The occurrence of surgical incision infection was similar in both groups. Compared with the awake group, the asleep group exhibited a shorter procedure duration with a similar electrode implantation accuracy and short-term motor improvement. Robot-assisted asleep DBS surgery is a promising surgical method for PD.

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“…Thus, to balance visibility, measurement accuracy, familiarity for many users, and broad applicability, we selected the T2 ∗ sequence, which is similar to the frequently used T2 sequence and has moderate susceptibility weighting capabilities. In addition, the 3T MRI used in the present study with or without frames may be better for visualization and direct targeting of DBS than is stereotactic 1.5T MRI (Cheng et al, 2014; Southwell et al, 2016).…”

Section: Discussionmentioning

confidence: 95%

“…However, MRI sequences with worse quality cannot be used. Worse MRI image contrast due to lower magnetic field (Cheng et al, 2014; Southwell et al, 2016), 1-mm thickness T2 slicing, and higher noise from metal artifacts or any cause (O’Gorman et al, 2011) can result in a lower contrast-to-noise ratio, which is not suitable for machine learning algorithm application.…”

Section: Discussionmentioning

confidence: 99%

Deep Learning-Based Deep Brain Stimulation Targeting and Clinical Applications

et al. 2019

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BackgroundThe purpose of the present study was to evaluate deep learning-based image-guided surgical planning for deep brain stimulation (DBS). We developed deep learning semantic segmentation-based DBS targeting and prospectively applied the method clinically.MethodsT2∗ fast gradient-echo images from 102 patients were used for training and validation. Manually drawn ground truth information was prepared for the subthalamic and red nuclei with an axial cut ∼4 mm below the anterior–posterior commissure line. A fully convolutional neural network (FCN-VGG-16) was used to ensure margin identification by semantic segmentation. Image contrast augmentation was performed nine times. Up to 102 original images and 918 augmented images were used for training and validation. The accuracy of semantic segmentation was measured in terms of mean accuracy and mean intersection over the union. Targets were calculated based on their relative distance from these segmented anatomical structures considering the Bejjani target.ResultsMean accuracies and mean intersection over the union values were high: 0.904 and 0.813, respectively, for the 62 training images, and 0.911 and 0.821, respectively, for the 558 augmented training images when 360 augmented validation images were used. The Dice coefficient converted from the intersection over the union was 0.902 when 720 training and 198 validation images were used. Semantic segmentation was adaptive to high anatomical variations in size, shape, and asymmetry. For clinical application, two patients were assessed: one with essential tremor and another with bradykinesia and gait disturbance due to Parkinson’s disease. Both improved without complications after surgery, and microelectrode recordings showed subthalamic nuclei signals in the latter patient.ConclusionThe accuracy of deep learning-based semantic segmentation may surpass that of previous methods. DBS targeting and its clinical application were made possible using accurate deep learning-based semantic segmentation, which is adaptive to anatomical variations.

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Comparison of Deep Brain Stimulation Lead Targeting Accuracy and Procedure Duration between 1.5- and 3-Tesla Interventional Magnetic Resonance Imaging Systems: An Initial 12-Month Experience

Cited by 23 publications

References 15 publications

Outcomes of Interventional-MRI Versus Microelectrode Recording-Guided Subthalamic Deep Brain Stimulation

Outcomes of Interventional-MRI Versus Microelectrode Recording-Guided Subthalamic Deep Brain Stimulation

A comparative study of asleep and awake deep brain stimulation robot-assisted surgery for Parkinson’s disease

Deep Learning-Based Deep Brain Stimulation Targeting and Clinical Applications

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