Brain Shift and Pneumocephalus Assessment During Frame-Based Deep Brain Stimulation Implantation With Intraoperative Magnetic Resonance Imaging.

Abstract

BACKGROUND:

Brain shift and pneumocephalus are major concerns regarding deep brain stimulation (DBS).

OBJECTIVE:

To report the extent of brain shift in deep structures and pneumocephalus in intraoperative magnetic resonance imaging (MRI).

METHODS:

Twenty patients underwent bilateral DBS implantation in an MRI suite. Volume of pneumocephalus, duration of procedure, and 6 anatomic landmarks (anterior commissure, posterior commissure, right fornix [RF], left fornix [LF], right putaminal point, and left putaminal point) were measured.

RESULTS:

Pneumocephalus varied from 0 to 32 mL (median = 0.6 mL). Duration of the procedure was on average 195.5 min (118-268 min) and was not correlated with the amount of pneumocephalus. There was a significant posterior displacement of the anterior commissure (mean = -1.1 mm, P < .001), RF (mean = -0.6 mm, P < .001), LF (mean = -0.7 mm, P < .001), right putaminal point (mean = -0.9 mm, P = .001), and left putaminal point (mean = -1.0 mm, P = .001), but not of the posterior commissure (mean = 0.0 mm, P = .85). Both RF (mean = -.7 mm, P < .001) and LF (mean = -0.5 mm, P < .001) were posteriorly displaced after a right-sided burr hole. There was a correlation between anatomic landmarks displacement and pneumocephalus after 2 burr holes (rho = 0.61, P = .007), but not after 1 burr hole (rho = 0.16, P = .60).

CONCLUSION:

Better understanding of how pneumocephalus displaces subcortical structures can significantly enhance our intraoperative decision making and overall targeting strategy.

• Authors: Caio M Matias, Leonardo A Frizon, Fadi Asfahan, Juan D Uribe, Andre G Machado
• Journal: Operative neurosurgery (Hagerstown, Md.) (Oper Neurosurg (Hagerstown)) Vol. 14 Issue 6 Pg. 668-674 (06 01 2018) ISSN: 2332-4260 [Electronic] United States
• PMID: 28973421 (Publication Type: Journal Article)

Topics

• Anatomic Landmarks
• Brain (diagnostic imaging)
• Deep Brain Stimulation (adverse effects, instrumentation, methods)
• Humans
• Intraoperative Neurophysiological Monitoring (methods)
• Magnetic Resonance Imaging (methods)
• Pneumocephalus (diagnostic imaging, etiology)
• Trephining (adverse effects)