Magnetic resonance-transcranial ultrasound fusion imaging: A novel tool for brain electrode location

Abstract

Magnetic resonance-ultrasound real-time fusion imaging of DBS electrodes is safe with distinct precautions and improves assessment of electrode location. It may lower the need for repeated CT or MRI scans in DBS patients.

Post-Operative Localization of Deep Brain Stimulation Electrodes in the Subthalamus Using Transcranial Sonography

“…Our findings confirm that TCS is a reliable, easily manageable, non‐invasive, and inexpensive method that enables identification of certain echogenic anatomic structures and measurement of DBS electrode positions in the STN, giving support to its use as an additional guidance for electrodes implantation .…”

“…To date, our experience intraoperatively has been limited to a small number of cases; however, we are trying to solve some limitations like the position of the stereotactic frame which sometimes can hamper the use of TCS in the peri‐auricular area parallel to the orbitomeatal line. The use of TCS for monitoring intracranial lead positioning in DBS procedures is supported by several studies published to date . Pre‐operative transcranial sonography for DBS lead placement targeting the STN in a PD patient showed easy visualization of the electrode and they also displayed the laterally running posterior cerebral artery at the corresponding level .…”

“…Moreover, because it is an easy, quick, and non‐ionizing visualization application, it may even be used in real‐time as a complementary guidance during surgical intervention . To date, our experience intraoperatively has been limited to a small number of cases; however, we are trying to solve some limitations like the position of the stereotactic frame which sometimes can hamper the use of TCS in the peri‐auricular area parallel to the orbitomeatal line.…”

“…More studies are necessary to improve the limitations of the technique and to further confirm its usefulness, as well as to assess and confirm its applications in other targets in PD surgery and even for other DBS indications. It may also prove to be a reliable diagnostic tool in the future . An intra‐operative study for the use of TCS is planned.…”

“…Moreover, a combination of preoperative MRI with real time TCS using fusion imaging has been proposed as a safe tool to improve postoperative control of DBS electrode location. However, a potential effect on DBS pulse generator function cannot entirely be excluded and, to our knowledge, no specific measurements in TCS of electrodes position and comparison or correlation with theoretical coordinates measured by CT/MRI have been performed .…”