gms | German Medical Science

72. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

06.06. - 09.06.2021

High impedance values during the implantation procedure of leads for deep brain stimulation

Erhöhte intraoperative Impedanzwerte während der Implantation von Elektroden für die Tiefe Hirnstimulation

Meeting Abstract

  • presenting/speaker Thomas Kriesen - Universitätsmedizin Rostock, Neurosurgery, Rostock, Deutschland
  • Matthias Löhle - Universitätsmedizin Rostock, Neurology, Rostock, Deutschland
  • Thomas Freiman - Universitätsmedizin Rostock, Neurosurgery, Rostock, Deutschland
  • René Reese - Universitätsmedizin Rostock, Neurology, Rostock, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 72. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgie. sine loco [digital], 06.-09.06.2021. Düsseldorf: German Medical Science GMS Publishing House; 2021. DocP094

doi: 10.3205/21dgnc382, urn:nbn:de:0183-21dgnc3825

Published: June 4, 2021

© 2021 Kriesen et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Objective: The implantation of electrodes into basal ganglia nuclei for deep brain stimulation (DBS) is a routine technique in the treatment of movement disorders. As a final step during the implantation procedure, impedance measures document correct technical functioning of the implanted system. Hence, abnormally high or low impedance measures may require extensive troubleshooting. We here present cases of abnormally high impedances and troubleshooting in a series of patients implanted with DBS electrodes.

Methods: We investigated the intraoperatively determined impedance measures of the DBS system in fifty consecutive patients implanted in our department. These measures were correlated to image findings in intra- and postoperative CT scans, to the implanted system, surgical incidents, total operating time, brain side for initial implantation and the number of microelectrodes used for evaluation of the target region.

Results: In all patients, leads and DBS systems were implanted without incident or complication. In 4 of 40 electrodes implanted with segmented directional leads, increased impedance values were measured (see Table for example). Operating time, brain side for initial implantation, and the number of microelectrodes did not differ to the patient group with normal impedance measures. The connections from electrodes to the extensions and to the stimulator (IPG) were electrically intact. In one patient, a CT scan directly after surgery revealed intracranial air around electrode contacts which was not apparent in the other patients who received their CT only one day later. In a repeated measurement of impedances, earliest two hours after surgery in one patient, all aberrant impedance values were returned to normal. In 5 of 60 electrodes implanted with electrodes with classical ring contacts, intraoperatively increased impedance values could invariably be solved by readjusting connections between cables and/or cables and IPG.

Conclusion: Intraoperative high impedance values of the DBS system should lead to extensive troubleshooting. If single segments of the directional lead contacts are identified as the most probable cause, surgery may be routinely completed and impedance measurement should be repeated two to four hours later. We found air around the leads in CT scans as the most probable cause of transient high impedance measures.

Figure 1 [Fig. 1], Table 1 [Tab. 1]