Minimizing Brain Shift during Functional Neurosurgical Procedures – A Simple Burr Hole Technique that can Decrease CSF Loss and Intracranial Air

Abstract

This new and simple burr hole technique was associated with a significant reduction in postoperative intracranial air. Reduction of intracranial air will ultimately reduce brain shift. That total operation time does not influence intracranial air is discussed as well as the limitations of this pilot series. In the authors' opinion, this straightforward and cost-effective technique has the potential to reduce brain shift and to increase DBS placement accuracy during functional stereotactic neurosurgical procedures performed in the seated or half-sitting position. A larger more standardized patient series is necessary to substantiate the findings.

Brain shift during bur hole–based procedures using interventional MRI

“…3,34 One report even identifies a new bur hole technique that minimizes pneumocephalus and therefore reduces brain shift. 1 Finally, our data show that reducing the number of passes to reach a target can reduce shift. Minimizing passes can be achieved with careful preoperative planning and with the help of intraoperative imaging.…”

Correlation of Active Contact Positions with the Electrophysiological and Anatomical Subdivisions of the Subthalamic Nucleus in Deep Brain Stimulation

“…This may also be an expression of brain shift due to cerebrospinal fluid leakage with a consecutive caudal shift of the brain, thus bringing an area recorded as dorsal to the STN into the proximity of what turns out to be the active contact after resolution of the brain shift. Although we used a technique avoiding major cerebrospinal fluid leakage [23], we cannot completely exclude this influence.…”

Functional MRI, Diffusion Tensor Imaging, Magnetic Source Imaging and Intraoperative Neuromonitoring Guided Brain Tumor Resection in Awake and Under General Anaesthesia

“…In this context, buoyant force exerts a lifting effect against gravity and creates a "floating brain". The buoyant environment is disturbed once either there is communication between our normal atmosphere with intracranial compartment (gradual obliteration of buoyant environment) or in presence of CSF leak (fast obliteration of buoyant environment) [25,26]. During craniotomy for brain tumor surgery, brain shift normally happens when there is removal of CSF.…”

“…Consequently, the localisation onto or into the brain as guided by the extraoperative neuroimages would become imprecise. Thus, surgery that requires precise brain localisation should pay meticulous attention to avoid CSF leak by appropriate positioning of the patient or by using intraoperative neuroimages [27,28]. Intraoperative neuroimages give updated images to the operating neurosurgeon which can be done on a regular basis.…”

“…Neuronal property of creating oscillation inside our brain is important for normal brain functioning. Neural oscillation contributes to neural coding, brain rhythms with different types or frequency of oscillatory activity [5 type of brain waves: gamma (above 30 Hz), beta [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30], alpha (8)(9)(10)(11)(12)(13), theta [4][5][6][7][8] and delta [0.5 -4 Hz); sleep spindles; Mu waves; thalamocortical oscillations; epileptic seizures and bursting] and fast information processing and transfer. Interestingly, neural oscillations also play an important role in many neurological disorders such as excessive synchronisation during seizure in epilepsy or tremors in movement disorders [69].…”