Accuracy of Frame-Based Stereotactic Magnetic Resonance Imaging vs Frame-Based Stereotactic Head Computed Tomography Fused With Recent Magnetic Resonance Imaging for Postimplantation Deep Brain Stimulator Lead Localization

• Published in: Neurosurgery Vol. 69; no. 6; pp. 1299 - 1306
• Main Authors: Pezeshkian, Patrick, DeSalles, Antonio A. F., Gorgulho, Alessandra, Behnke, Eric, McArthur, David, Bari, Ausaf
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Oxford University Press 01.12.2011; Lippincott Williams & Wilkins; Wolters Kluwer Health, Inc
• Subjects: Accuracy; Adolescent; Adult; Aged; Aged, 80 and over; Biological and medical sciences; Brain Diseases - pathology; Brain Diseases - therapy; Brain Mapping; Deep brain stimulation; Deep Brain Stimulation - methods; Electrodes, Implanted; Female; Humans; Localization; Magnetic Resonance Imaging; Male; Medical sciences; Middle Aged; Neurosurgery; Postoperative Period; Retrospective Studies; Stereotaxic Techniques; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Tomography; Tomography, X-Ray Computed; Young Adult; Accuracy; Postimplantation intraoperative computed tomography; Postimplantation intraoperative magnetic resonance imaging; Stereotactic surgery; Deep brain stimulation; Frame; Nervous system diseases; Head; Intraoperative; Stimulator; Stereotaxia; Nuclear magnetic resonance imaging; Encephalon; Surgery; Computerized axial tomography
• ISSN: 0148-396X; 1524-4040
• DOI: 10.1227/NEU.0b013e31822b7069

Abstract BACKGROUND Introduction of the portable intraoperative CT scanner provides for a precise and cost-effective way of fusing head CT images with high-tesla MRI for the exquisite definition of soft tissue needed for stereotactic targeting. OBJECTIVE To evaluate the accuracy of stereotactic electrode placement in patients undergoing deep brain stimulation (DBS) by comparing frame-based postimplantation intraoperative CT (iCT) images fused to a recent 3T-MRI with frame-based postimplantation intraoperative MRI (iMRI) alone. METHODS Frame-based DBS surgeries of 46 targets performed from February 8, 2007 to April 28, 2008 in 26 patients with the use of immediate postimplantation iMRI for target localization were compared with frame-based immediate postimplantation iCT fused with a recent 3T brain MRI for DBS localization of 50 targets performed from August 13, 2008 to February 18, 2010 in 26 patients. Pre- and postoperative mid anterior commissure-posterior commissure line coordinates and XYZ coordinates for preoperatively calculated DBS targets (intended target) and for the permanent DBS lead tips were determined. The differences between preoperative DBS target and postoperative permanent DBS lead-tip coordinates based on postimplantation intraoperative MRI for the MRI-alone group and based on postimplantation intraoperative CT fused to recent preoperative MRI in the CT-MRI group were measured. The t test and Yuen test were used for comparison. RESULTS No statistically significant differences were found between the 2 groups when comparing the pre- and postperative changes in mid anterior commissure-posterior commissure line coordinates and XYZ coordinates. CONCLUSION Postimplantation DBS lead localization and therefore targeting accuracy was not significantly different between frame-based stereotactic 1.5T-MRI and frame-based stereotactic head CT fused with recent 3T-MRI.