Influence of stereotactic imaging on operative time in deep brain stimulation

Abstract

Background: Various techniques are used across institutions for implantation of deep brain stimulation (DBS) leads. The most used techniques for each step include preoperative MRI fused to in-frame CT, intraoperative fluoroscopy, and postoperative CT, but postimplantation MRI also is used, as it was at our center. We present the quality assurance study performed at our institution after a change from postimplantation MRI performed across the hospital to postimplantation in room CT. Methods: Retrospective chart review of 123 patients who underwent bilateral DBS leads placement without same-day generator placement that was performed. The patients were divided by the type of postoperative imaging that was obtained. Patients were excluded if a unilateral lead placement was performed, if the case was a revision of an existing lead or deviated from the normal protocol. Operative room times and procedure times for each group were analyzed with Wilcoxon rank sums test (WRST) to determine any significant differences between groups. Results: Postoperative MRI was performed for 82 patients, while postoperative CT was performed for 41 patients. A WRST showed a significant reduction in both operative room time (209 min to 170 min, P < 0.0001) and procedure time (140 min to 126 min, P = 0.0019). Conclusion: In-room CT allowed for a significant reduction in operative room time. Lower operative room time has been associated with increased patient comfort, and decreased cost. CT did not alter the revision rate for procedures. The significant reduction in procedure time may be attributed to increased team familiarity with procedure over time.

Impedance trend from a symptomatic perielectrode cystic cavity following deep brain stimulation: illustrative case

“…He was evaluated through the multidisciplinary movement disorders program for DBS candidacy and was scheduled to undergo bilateral DBS targeting the left and right subthalamic nucleus (STN) using a two-stage approach with compact spaced leads (Medtronic 3389) following our center’s surgical standard, and immediate postoperative images confirming lead placement did not show any cystic lesions around the electrode. 8 The initial programming visit was completed 15 days after lead implantation without incident. On postimplant day 46, the patient had abruptly developed right-sided veering while ambulating, dysarthria, right-sided facial droop, and falls when moving to the right and was admitted for observation.…”