Artikel
Early postoperative 3D CT for the detection of the true electrode position after DBS surgery
Bestimmung der erzielten Elektrodenposition nach tiefer Hirnstimulation mittels frühem postoperativem 3D CT
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Autoren
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V. Coenen
- Neurochirurgische Klinik, UKA Aachen, Deutschland
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B. Marks
- Neurochirurgische Klinik, UKA Aachen, Deutschland
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P. Reinacher
- Neurochirurgische Klinik, UKA Aachen, Deutschland
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C. Fromm
- Neurologische Klinik, UKA Aachen, Deutschland
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M. Kronenbürger
- Neurologische Klinik, UKA Aachen, Deutschland
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P. Niggemann
- Lehr- und Forschungsgebiet Neuroradiologie, UKA Aachen, Deutschland
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J. Gilsbach
- Neurochirurgische Klinik, UKA Aachen, Deutschland
| Veröffentlicht: | 30. Mai 2008 |
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Gliederung
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Objective: The gold standard for the postoperative detection of the position of DBS electrodes is magnetic resonance imaging (MRI). It shows individual electrode contacts together with the anatomical environment. However, MRI with an implanted DBS system poses a potential hazard on the patient and is prone to distortion artifacts. We hypothesize that early postoperative 3D computed tomography (3DCT) – when fused to the preoperative MRI planning data – is a valid alternative to detect the achieved electrode position.
Methods: Overall, 18 patients were included (11 Parkinson disease (PD), 7 Essential Tremor (ET)). There were 13 male and 5 female patients with an age range of 41-79 years (mean: 66±9 years). A helical 3DCT of the whole head was acquired in axial direction without stereotactic frame within 10 hours after surgery (Siemens Volumezoom 4 plus, 1mm, 120 KV, 306 mA, typically 200-230 cuts). The CT data were transferred to a workstation (Framelink 4, Stealth Station, Medtronic SNT, USA) and fused to preoperative planning data. The coordinates of in situ placed electrode contacts (CT) were obtained and compared to planned contact positions (MRI) by determining distances (mm) between the two, as directions in 3D (x,y,z).
Results: For the laterality (x-axis), there was a mean distance of 0.8±0.5 mm (Range 0-2.2 mm). 70% of contacts appeared deflected medially (84 contacts). For antero-posterior (y-axis), there was a mean distance of 1±0.8 mm (Range 0.01-2.7 mm). 77.5% (93 contacts) were detected anteriorly. For verticality (z-axis) a mean distance of 0.9±0.7 mm (Range 0.01-3.2 mm) was detected. 61.7% (74 contacts) were deflected superiorly. No postoperative bleedings were seen.
Conclusions: Early postoperative CT is a valid alternative to MRI for detecting the immediately achieved electrode position after DBS surgery. Its accuracy is comparable to MRI. Programming changes for the INS device over weeks suggest, that postoperative brain shift might lead to an ongoing change in electrode position and possibly should be investigated with follow-up serial 3D CT.
