Artikel
Deviation of lead orientation angle of dDBS leads on intraoperative STX-XR
Bestimmung der räumlichen Ausrichtung segmentierter Elektroden nach stereotaktischer Implantation zur Tiefen Hirnstimulation mit Hilfe von intraoperativem stereotaktischen Röntgen
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Veröffentlicht: | 4. Juni 2021 |
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Gliederung
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Objective: Due to multiple programming options of directional deep brain stimulation (dDBS) in movement disorder patients knowledge of the lead orientation angle is useful for effective programming. A recent study demonstrated deviations of up to 90° from the intended orientation angle on postoperative cCT-scans (Dembek et al. 2019). In the actual study we examined the deviation of dDBS-lead orientation on intraoperative stereotactic (STX) x-ray images.
Methods: Two blinded investigators determined retrospectively on intraoperative 2D-stereotactic x-ray images the orientation of the stereotactic marker of dDBS-leads for 64 consecutive patients. The leads were stereotactically implanted with the spatial marker in rostral direction. X-ray Images were taken routinely after implantation of the first and the second lead enabling the determination of the spatial orientation of the first lead at two different time points.
Results: The mean deviation between intended and final spatial orientation was 40,8° ± 46,08° for all examined leads (N=128). The spatial orientation of the first lead did not significantly change within an average observation time of 60 minutes (N=64, Z=-0.11, p=0,916, Wilcoxon-Signed-Rank-Test). Also, the degree of deviation did not differ significantly between two lead manufacturers (group A (N=44), group B (N=84); Man-Whitney-U-Test, U=1629,500, Z=-1,098, p=0,272).
Conclusion: Our results showed deviations from the intended orientation angle due to electrode rotation immediately after the insertion of dDBS leads independent from the manufacturer. The initial spatial orientation remained stable for approximately one hour. This observation suggests that spatial deviations are a consequence of intraoperative manual manipulation so that a standardized orientation of dDBS leads is difficult to achieve.