Perioperative Brain Shift and Deep Brain Stimulating Electrode Deformation Analysis: Implications for rigid and non-rigid devices

Sillay, Karl; Kumbier, Lauren; Ross, Chris; Brady, Martin; Alexander, Andrew L.; Gupta, Aman; Adluru, Nagesh; Miranpuri, Gurwattan S.; Williams, Justin

doi:10.1007/s10439-012-0650-0

Cited by 44 publications

(28 citation statements)

References 17 publications

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“…A tight-fitting stylet that covers the endport during insertion and is then withdrawn before infusion eliminated the tissue coring and the corresponding pressure spike at the start of infusion. It can be argued that the distance covered by the catheter in a push through is much greater than in a normal insertion, yet infusions into deep brain structures such as the subthalamic nucleus (STN) in humans can be 8 cm deep, as can be inferred by careful measurements during DBS placements [23] (see Table 2 of the reference).…”

Section: Discussionmentioning

confidence: 99%

The Relation between Catheter Occlusion and Backflow during Intraparenchymal Cerebral Infusions

Brady¹,

Raghavan²,

Block³

et al. 2015

Stereotact Funct Neurosurg

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Background/Aims: The distribution of infusate into the brain by convection-enhanced delivery can be affected by backflow along the catheter shaft. This work assesses the following: (1) whether tissue coring and occlusion of the catheter lumen occurs when an open end-port catheter is inserted, (2) whether there is a relationship between intracatheter pressure and backflow, and (3) whether catheter occlusion increases backflow. Methods: Freshly excised monkey brains were used to assess tissue coring and its correlation with the behavior of the line pressure. In vivo infusions of gadolinium solution into monkey putamen at 1 μl/min were conducted with and without a stylet during insertion. The effect of flow during insertion was evaluated in vivo in the pig thalamus. MRI and line pressure were continuously monitored during in vivo infusions. Results: Ex vivo testing showed that open end-port insertions always cored tissue (which temporarily plugs the catheter tip) and increased pressure followed by a rapid fall after its expulsion. Catheter insertion with a stylet in place prevented coring but not flow insertion; neither affected backflow. Conclusion: Open end-port catheters occlude during insertion, which can be prevented by temporarily closing the port with a stylet but not by infusing while inserting. Backflow was not completely prevented by any insertion method.

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Section: Discussionmentioning

confidence: 99%

The Relation between Catheter Occlusion and Backflow during Intraparenchymal Cerebral Infusions

Brady¹,

Raghavan²,

Block³

et al. 2015

Stereotact Funct Neurosurg

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“…Complications involved during bore hole craniotomy procedures, where air immediately rushes into the subdural space between brain and skull causing movement of the tissue relative to the skull. 23,24 …”

Section: Discussionmentioning

confidence: 99%

“…A similar study based on 12 patients experiencing brain shift while considering effects on other treatments and future treatments was previously performed. 24 Brain shift and subsequent electrode displacement and deformation may occur in all patients undergoing DBS as a treatment option. Brain shift may have greater detrimental effects on future treatments, especially those performed in the supine position and those administered with a rigid catheter instead of a flexible electrode with proposed infusion times measured in hours.…”

Section: Discussionmentioning

confidence: 99%

“…Brain shift may have greater detrimental effects on future treatments, especially those performed in the supine position and those administered with a rigid catheter instead of a flexible electrode with proposed infusion times measured in hours. 24 A nonlinear poroelasticity-based treatment may confine the fluid flow and drug transport to the interstitial space. 4 Microdialysis use may effectively target the major genes responsible for dopamine synthesis and processing and provide alternative options for gene delivery.…”

Section: Discussionmentioning

confidence: 99%

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Convection Enhanced Delivery: A Comparison of infusion characteristics in ex vivo and in vivo non-human primate brain tissue

Miranpuri

Hinchman

Wang

et al. 2013

ANS

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BackgroundConvection enhanced delivery (CED) is emerging as a promising infusion toolto facilitate delivery of therapeutic agents into the brain via mechanically controlled pumps. Infusion protocols and catheter design have an important impact on delivery. CED is a valid alternative for systemic administration of agents in clinical trials for cell and gene therapies. Where gel and ex vivo models are not sufficient in modeling the disease, in vivo models allow researchers to better understand the underlying mechanisms of neuron degeneration, which is helpful in finding novel approaches to control the process or reverse the progression. Determining the risks, benefits, and efficacy of new gene therapies introduced via CED will pave a way to enter human clinical trial.PurposeThe objective of this study is to compare volume distribution (Vd)/ volume infused (Vi) ratios and backflow measurements following CED infusions in ex vivo versus in vivo non-human primate brain tissue, based on infusion protocols developed in vitro.MethodsIn ex vivo infusions, the first brain received 2 infusions using a balloon catheter at rates of 1 μL/min and 2 μL/min for 30 minutes. The second and third brains received infusions using a valve-tip (VT) catheter at 1 μL/min for 30 minutes. The fourth brain received a total of 45 μL infused at a rate of 1 μL/min for 15 minutes followed by 2 μL/min for 15 minutes. Imaging was performed (SPGR FA34) every 3 minutes. In the in vivo group, 4 subjects received a total of 8 infusions of 50 μL. Subjects 1 and 2 received infusions at 1.0 μL/min using a VT catheter in the left hemisphere and a smart-flow (SF) catheter in the right hemisphere. Subjects 3 and 4 each received 1 infusion in the left and right hemisphere at 1.0 μL/min.ResultsMRI calculations of Vd/Vi did not significantly differ from those obtained on post-mortem pathology. The mean measured Vd/Vi of in vivo (5.23 + /-1.67) compared to ex vivo (2.17 + /-1.39) demonstrated a significantly larger Vd/Vi for in vivo by 2.4 times (p = 0.0017).ConclusionWe detected higher ratios in the in vivo subjects than in ex vivo. This difference could be explained by the extra cellular space volume fraction. Studies evaluating backflow and morphology use in vivo tissue as a medium are recommended. Further investigation is warranted to evaluate the role blood pressure and heart rate may play in human CED clinical trials.

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“…Advances in catheter design 10 , infusion technique 11 , line pressure monitoring 2 , and real time MRI monitoring to correct for brain shift 12,13 , optimize multiple collinear infusions 14 , and monitor for infusate loss 15 have increased the safety and efficacy of the treatment 10 . Additional importance has been placed on the catheter design and infusion strategy including flow rate.…”

Section: Introductionmentioning

confidence: 99%

Image-guided Convection-enhanced Delivery into Agarose Gel Models of the Brain

Sillay¹,

McClatchy²,

Shepherd³

et al. 2014

JoVE

Self Cite

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Convection-enhanced delivery (CED) has been proposed as a treatment option for a wide range of neurological diseases. Neuroinfusion catheter CED allows for positive pressure bulk flow to deliver greater quantities of therapeutics to an intracranial target than traditional drug delivery methods. The clinical utility of real time MRI guided CED (rCED) lies in the ability to accurately target, monitor therapy, and identify complications. With training, rCED is efficient and complications may be minimized. The agarose gel model of the brain provides an accessible tool for CED testing, research, and training. Simulated brain rCED allows practice of the mock surgery while also providing visual feedback of the infusion. Analysis of infusion allows for calculation of the distribution fraction (Vd/Vi) allowing the trainee to verify the similarity of the model as compared to human brain tissue. This article describes our agarose gel brain phantom and outlines important metrics during a CED infusion and analysis protocols while addressing common pitfalls faced during CED infusion for the treatment of neurological disease. Video LinkThe video component of this article can be found at

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Perioperative Brain Shift and Deep Brain Stimulating Electrode Deformation Analysis: Implications for rigid and non-rigid devices

Cited by 44 publications

References 17 publications

The Relation between Catheter Occlusion and Backflow during Intraparenchymal Cerebral Infusions

The Relation between Catheter Occlusion and Backflow during Intraparenchymal Cerebral Infusions

Convection Enhanced Delivery: A Comparison of infusion characteristics in ex vivo and in vivo non-human primate brain tissue

Image-guided Convection-enhanced Delivery into Agarose Gel Models of the Brain

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