Intraoperative CT verification of electrode localization in DBS surgery in Parkinson's disease

Abstract

Background: Precise and accurate placement of electrodes in DBS surgery is essential in achievement of proper therapeutical effect in movement disorders. Verification of their position in the target is necessary. It can be performed postoperatively. But more convenient for the patient is an intraoperative CT imaging in the operating room. We evaluated the results of DBS electrodes implantation in patients with Parkinson's disease by intraoperative CT. Case series: 21 patients with Parkinson's disease were operated in 2010–2012 in the Military Clinical Hospital in Bydgoszcz, Poland. Standard procedure of electrode implantation was verified by intraoperative CT in operating room. CT scans were fused with preoperative MRI plan of target (STN) and trajectory and accuracy were assessed. Results: Mean differences between positions of tips of electrodes implanted and intended coordinates of targets were: 0.9 mm; 1.6 mm; and 0.8 mm in horizontal line, in vertical line, and in lateral line respectively and remain within the limits of the intraoperative CT resolution. In 1 case the accuracy was not satisfying and replacement of electrodes in one stage surgery was required. Conclusions: Intraoperative CT is a helpful tool in DBS procedures and enables comparison of preoperative plans with the final trajectory and localization of the tip of electrode visualized in CT in appropriate target. It eliminates necessity of post-op verification outside the operating room. All changes can be done during the procedure. It also allows to rule out the intracerebral haematoma caused by implantation.

Keywords

• Deep brain stimulation
• Parkinson's disease
• Intraoperative CT
• Image fusion
• Functional neurosurgery