Isolation of the Brain-Related Factor of the Error Between Intended and Achieved Position of Deep Brain Stimulation Electrodes Implanted Into the Subthalamic Nucleus for the Treatment of Parkinson's Disease

Daniluk, Slawomir; Davies, Keith G.; Novák, Péter; Vu, Thai; Nazzaro, Jules M.; Ellias, Samuel

doi:10.1227/01.neu.0000335171.38334.39

Cited by 10 publications

(12 citation statements)

References 30 publications

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“…These systems can be classified into 3 groups, the frame-based, the frameless and the iMRI-guided systems. The frame-based systems include the Leksell system (Elekta Instruments Inc., Sweden) [18,31,41], the Zamorano-Dujovny system (Stryker-Leibinger Inc., Germany) [19], the Riechert-Mundinger system (Innomed Pte Ltd., Germany) [20], the Cosman-Roberts-Wells system (Radionics Inc., USA) [17,39,42] and the Neuromate robot (Renishaw Inc., UK) [43]. The frameless systems include NexFrame (Image-Guided Neurologics Inc., USA) [21,26,32] and the STarFix microTargeting Platform (FHC Inc., USA) [22,27,44].…”

Section: Resultsmentioning

confidence: 99%

“…According to the principle of precision engineering, one should avoid applying the anchoring force in the direction of lead migration or the migration-sensitive direction. Currently, 3 representative devices for anchoring the DBS lead are the titanium miniplate [19,65], Medtronic burr hole ring and cap (Medtronic Inc.) supplied in the DBS lead package [68], and Stimloc cranial base and cap (Medtronic Inc., its old commercial name: Navigus; information acquired through personal communication with Medtronic Inc.) [38,42,65]. As illustrated in figure 7b, the anchoring forces exerted by the titanium miniplate, Stimloc and Medtronic cap are F mini , F S and F M , respectively.…”

Section: Discussionmentioning

confidence: 99%

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Review on Factors Affecting Targeting Accuracy of Deep Brain Stimulation Electrode Implantation between 2001 and 2015

Li¹,

Zhang

Yan

et al. 2016

Stereotact Funct Neurosurg

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Background: Accurate implantation of a depth electrode into the brain is of the greatest importance in deep brain stimulation (DBS), and various stereotactic systems have been developed for electrode implantation. However, an updated analysis of depth electrode implantation in the modern era of DBS is lacking. Objective: This study aims at providing an updated review on targeting accuracy of DBS electrode implantation by analyzing contemporary DBS electrode implantation operations from the perspective of precision engineering. Methods: Eligible articles with information on targeting accuracy of DBS electrode implantation were searched in the PubMed database. Results: An average targeting error of DBS electrode implantation is reported to decrease toward 1 mm; the standard deviation of targeting error is decreasing toward 0.5 mm. Targeting accuracy is not only found to be affected by individual surgical steps, but also systematically affected by the architecture of the implantation operation. Conclusion: A systematic strategy should be adopted to further improve the targeting accuracy of depth electrode implantation. Attention should be paid to optimizing the whole electrode implantation operation, which can help minimize error accumulation or amplification throughout the serially connected procedures for DBS electrode implantation.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Review on Factors Affecting Targeting Accuracy of Deep Brain Stimulation Electrode Implantation between 2001 and 2015

Li¹,

Zhang

Yan

et al. 2016

Stereotact Funct Neurosurg

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“…There was no difference between brain hemispheres. Bending of electrode was described, and as the cause of this bending was not specifi ed "brain related" factor was expected (21).…”

Section: Discussionmentioning

confidence: 99%

Prevalent placement error of deep brain stimulation electrode in movement disorders (technical considerations)

Kloc¹,

Košutzká²,

Štěňo³

et al. 2017

BLL

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BACKGROUND: Deep brain stimulation is an effective and safe technique. Displacement of the electrode relative to the optimal stimulation site can lead to insuffi cient effect and sometimes to the need of operative electrode re-position. OBJECTIVE: This study was aimed to analyse targeting accuracy of deep brain stimulation electrode implantation to subthalamic nucleus (STN) and globus pallidus internus (Gpi). It detected possible causes of inaccuracy and prevalent shift to certain direction. METHODS: Targeting accuracy was analysed in 47 patients with Parkinson´s disease (PD) and 11 patients with dystonia with bilateral implantation of deep brain stimulation electrodes between years 2009 and 2016. RESULTS: A shift of electrode to prevalent direction was observed on the left side to medial and posterior and on the right side to lateral direction. Greater shift was observed on the left side and in a higher angulation of trajectory laterally. Movement of the electrode, because of its traction in anchoring device, was identifi ed as a possible factor for prevalent electrode shift. Calibration of stereotactic coordinates to correct prevalent shift was used. CONCLUSION: Targeting inaccuracy is the result of accumulation of errors in individual steps of electrode implantation. Direction of the shift can be random or it can be toward a prevalent direction. A correction of prevalent error can prevent a suboptimal electrode placement (Tab. 3, Fig. 11, Ref. 29). Text in PDF www.elis.sk.

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“…[346] Our surgical method to accomplish bilateral STN DBS over staged procedures has been described previously. [267] In the present case, on the morning of the first lead implantation, 1.5 T magnetic resonance imaging (MRI) brain scanning (Signa Excite HDx, General Electric Medical Systems, Milwaukee, WI) was performed for direct target purposes, following placement of a stereotactic frame (MRIA-UHRA, Integra Radionics, Burlington, MA). A paraventricular approach was planned (NeuroSight Arc 2.5, Integra Radionics) avoiding sulci and vessels and using a gyrus close to the inner skull bone for brain entry.…”

Section: Methodsmentioning

confidence: 99%

The importance of testing deep brain stimulation lead impedances before final lead implantation

Nazzaro

Lyons²,

Pahwa³

et al. 2011

Surg Neurol Int

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Background:In the setting of a deep brain stimulation (DBS) lead with defective electrical circuitry, potential patient morbidity and additional surgery may be avoided if impedance testing of the brain lead is performed prior to final lead implantation. In the present report, detection of a short circuit upon lead placement and prior to lead anchoring was detected utilizing recently released DBS hardware and software (Medtronic, Minneapolis, MN). This report suggests that neurosurgeons need to be aware and consider the use of the newly available DBS testing equipment.Methods:During the first DBS lead placement in a 69-year-old man with advanced idiopathic Parkinson's disease undergoing bilateral subthalamic nucleus DBS over staged procedures, test stimulation and lead impedance testing were accomplished prior to lead anchoring. An external neurostimulator (ENS) was affixed to an updated clinician programmer and connected to the DBS lead with a screening cable specific for the ENS and DBS.Results:Impedance testing demonstrated a short circuit involving the 1 and 3 lead-electrode bipolar combination in a visually intact lead. The lead was replaced, repeat impedance testing and test stimulation were completed and the intact lead was secured. Subsequent DBS surgeries were completed uneventfully. The lead abnormality was verified by the manufacturer.Conclusions:This case highlights a new method to test DBS lead circuitry at the time of placement. The method may also be employed to directly test lead integrity when localizing a DBS system short or open circuit of unclear etiology. Our case suggests that the method is valuable and should be utilized.

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Isolation of the Brain-Related Factor of the Error Between Intended and Achieved Position of Deep Brain Stimulation Electrodes Implanted Into the Subthalamic Nucleus for the Treatment of Parkinson's Disease

Abstract: Elimination of the technical factors of error during STN deep brain stimulation implantation can result in a consistent posteromedial error. Implantation accuracy may be improved by compensation for this error in advance.

Cited by 10 publications

References 30 publications

Review on Factors Affecting Targeting Accuracy of Deep Brain Stimulation Electrode Implantation between 2001 and 2015

Review on Factors Affecting Targeting Accuracy of Deep Brain Stimulation Electrode Implantation between 2001 and 2015

Prevalent placement error of deep brain stimulation electrode in movement disorders (technical considerations)

The importance of testing deep brain stimulation lead impedances before final lead implantation

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