Do directional deep brain stimulation leads rotate after implantation?

Krüger, Marie T.; Naseri, Yashar; Cavalloni, Fabian; Reinacher, Peter C.; Kägi, Georg; Weber, W.; Brogle, Deborah; Bozinov, Oliver; Hägele-Link, Stefan; Brugger, Florian

doi:10.1007/s00701-020-04568-3

Cited by 13 publications

(38 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…60 minutes after implantation of the rst lead) was not signi cant if compared to TP1 indicating that unintended lead rotation is a very early event. This assumption is in line with the observation of other studies, which reported stable positioning for time latencies of 4-9 days or a median time latency of 82 (range 1-811) days [2,3,11].…”

Section: Discussion/ Conclusionsupporting

confidence: 92%

“…Using rotational uoroscopy several weeks to months after implantation deviations from the intended orientation up to 30° were registered [18]. Krüger et al reported a median deviation of 26.5° (5.5-62.0°) for a time period of 108-189 minutes (intraoperative position compared to postoperative CT), when only the marker orientation was used [11]. In the study of Dembeck et al postoperative CT-scans (CT examination approx.…”

Section: Discussion/ Conclusionmentioning

confidence: 99%

“…One important point with conceivable effects on electrode rotation could be the lead xation technique used [11]. Burr-hole caps provided by lead manufacturers can induce torsion that is likely to be of a different magnitude than the torsion caused by xing the leads with microplates (TM-technique) or using a clip-cement combination (TC-technique).…”

Section: Discussion/ Conclusionmentioning

confidence: 99%

“…For determination of the rotational angle directional leads are equipped with an x-ray marker close to the electrode tip. Several studies using imaging data from patients showed that there can be a signi cant difference between the intended and the nal lead orientation [3,11]. In addition, depending on the imaging modality and/or the access angle of the lead determination of the rotational angle might be prone to errors [20].…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Deviation of the Orientation Angle of Direction Deep Brain Stimulation Leads Quantified by Intraoperative Stereotactic X-ray Imaging

Schmidt

Buentjen

Kaufmann

et al. 2022

Preprint

View full text Add to dashboard Cite

Objective: Directional deep brain stimulation (dDBS) provides multiple programming options. Knowledge of the spatial lead orientation is useful for time efficient programming. Recent studies demonstrated deviations of up to 90° from the intended orientation angle. We examined the deviation of dDBS-lead orientation for leads from two different manufacturers using intraoperative stereotactic (STX) x-ray images.Methods: Intraoperative 2D-x-ray images were acquired after implantation of the first lead (TP1) and the second lead (TP2) enabling the estimation of the spatial position of the first lead at TP1 and TP2 and of changes of the orientation for a defined time period. Two investigators retrospectively estimated the orientation of the directional marker for 64 patients.Results: The mean deviation from intended spatial orientation was 40,8° ± 46.1° for all examined leads. The spatial orientation of the first lead did not significantly change within a period of approximately one hour. The degree of deviation did not differ significantly between two lead manufacturers but depended on the lead fixation technique.Conclusion: Our results showed deviations from the intended orientation angle immediately after the insertion of dDBS leads. The initial spatial orientation remained stable for approximately one hour and was not caused by technical properties of the implanted lead. Hence it was most probably the result of unintended mechanical torsion during insertion and/or fixation. Because precise determination of the lead orientation is mandatory for target-oriented dDBS programming the use of additional imaging suitable for precise 3D-visualization of lead contacts and/or the positioning marker is recommended.

show abstract

Section: Discussion/ Conclusionsupporting

confidence: 92%

Section: Discussion/ Conclusionmentioning

confidence: 99%

Section: Discussion/ Conclusionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Deviation of the Orientation Angle of Direction Deep Brain Stimulation Leads Quantified by Intraoperative Stereotactic X-ray Imaging

Schmidt

Buentjen

Kaufmann

et al. 2022

Preprint

View full text Add to dashboard Cite

show abstract

“…When a dDBS electrode is implanted with torque or when the rotation is corrected intraoperatively by rotating it at the burr a b c d hole, it takes some time until the rotational torque is transferred to the level of contacts. It has been suggested that there is no rotation over time in leads that do not show rotational deviation during or right after the implantation [12], which might be true in dDBS electrodes implanted without torque.…”

Section: Discussionmentioning

confidence: 99%

Deep brain stimulation electrodes may rotate after implantation—an animal study

et al. 2020

View full text Add to dashboard Cite

Directional deep brain stimulation (dDBS) electrodes allow to steer the electrical field in a specific direction. When implanted with torque, they may rotate for a certain time after implantation. The aim of this study was to evaluate whether and to which degree leads rotate in the first 24 h after implantation using a sheep brain model. dDBS electrodes were implanted in 14 sheep heads and 3D rotational fluoroscopy (3D-RF) scans were acquired to visualize the orientation of the electrode leads. Electrode leads were clockwise rotated just above the burr holes (180° n = 6, 360° n = 6, 2 controls) and 3D-RF scans were again acquired after 3, 6, 13, 17, and 24 h, respectively. One hundred eighty degree rotated electrodes showed an initial rotation of 83.5° (range: 35.4°–128.3°) and a rotation of 114.0° (range: 57°–162°) after 24 h. With 360° torsion, mean initial rotation was 201° (range: 3.3°–321.4°) and mean rotation after 24 h 215.7° (range 31.9°–334.7°), respectively. Direct postoperative imaging may not be accurate for determining the rotation of dDBS electrodes if torque is present.

show abstract

Deviation of the orientation angle of directional deep brain stimulation leads quantified by intraoperative stereotactic X-ray imaging

et al. 2022

View full text Add to dashboard Cite

Directional deep brain stimulation (dDBS) provides multiple programming options. Knowledge of the spatial lead orientation is useful for time-efficient programming. Recent studies demonstrated deviations of up to 90° from the intended orientation angle. We examined the deviation of dDBS-lead orientation for leads from two different manufacturers using intraoperative stereotactic (STX) X-ray images. Intraoperative 2D-X-ray images were acquired after implantation of the first lead (TP1) and the second lead (TP2) enabling the estimation of the spatial position of the first lead at TP1 and TP2 and of changes of the orientation for a defined time period. Two investigators retrospectively estimated the orientation of the directional marker for 64 patients. The mean deviation from intended spatial orientation was 40.8° ± 46.1° for all examined leads. The spatial orientation of the first lead did not significantly change within a period of approximately 1 h. The degree of deviation did not differ significantly between two lead manufacturers but depended on the lead fixation technique. Our results showed deviations from the intended orientation angle immediately after the insertion of dDBS leads. The initial spatial orientation remained stable for approximately 1 h and was not caused by technical properties of the implanted lead. Hence, it was most probably the result of unintended mechanical torsion during insertion and/or fixation. Because precise determination of the lead orientation is mandatory for target-oriented dDBS programming, the use of additional imaging suitable for precise 3D visualization of lead contacts and/or the positioning marker is recommended.

show abstract

Do directional deep brain stimulation leads rotate after implantation?

Cited by 13 publications

References 11 publications

Deviation of the Orientation Angle of Direction Deep Brain Stimulation Leads Quantified by Intraoperative Stereotactic X-ray Imaging

Deviation of the Orientation Angle of Direction Deep Brain Stimulation Leads Quantified by Intraoperative Stereotactic X-ray Imaging

Deep brain stimulation electrodes may rotate after implantation—an animal study

Deviation of the orientation angle of directional deep brain stimulation leads quantified by intraoperative stereotactic X-ray imaging

Contact Info

Product

Resources

About