DEEP BRAIN STIMULATION

Intraoperative CT is helping shape the future of DBS surgery

 

What is DBS?

Deep Brain Stimulation (DBS) is a neurological procedure involving the implantation of electrodes and a neuro-stimulator device to relieve symptoms of several major neurological disorders. The small, pacemaker-like device sends electronic signals to the electrodes, which are surgically placed in specific areas of the brain that control movement. These signals block some of the brain messages that cause disabling neurological symptoms (shaking, tremors, rigidity, stiffness and difficulty in movement).

What are the indications for DBS?

Over the past decade, DBS has become the standard of care for Parkinson’s disease (PD) and essential tremor when the patient is becoming non-responsive to medication. DBS can relieve symptoms of rigidity, dystonia, and essential tremor. Currently, DBS is being researched for use in obsessive compulsive disorder, Alzheimer’s disease, major depressive disorder, Tourette’s, drug addiction and severe aggression disorder.

How is the surgery performed?

There are currently two methods for performing DBS surgery:

“Awake” microelectrode-guided DBS

DBS surgery is most commonly performed with a stereotactic frame on a patient that is given a mild sedative. DBS electrode placement in the “awake” patient using a stereotactic frame has been the gold standard for the past 15 years. The electrodes are implanted based on the symptoms displayed by the patient. The implant site or sites are pretested in the operating theater using microelectrode recording (MER). MER gives the surgeon immediate feedback about the patient’s functional neurological patterns allowing them to locate the optimal placement for DBS leads. DBS leads are then placed and tested for efficacy in the operating theater, thus the reason for keeping the patient semi-conscious.

“Asleep” interventional CT-guided (iCT) DBS

Asleep interventional CT-guided procedure allows DBS electrodes to be implanted with the patient asleep (vs. awake) with the use of a portable CT scanner in the operating room. Patients may now undergo the surgery without having a frame placed on their heads and without having to be awake.

What are the benefits of intraoperative CT (iCT) during DBS procedures?

The advantages of adding intraoperative imaging to DBS surgical workflow are numerous.

  • Ability to check for anatomical location of the lead, brain shift, and unexpected vasculature before performing a second, third, or forth cannula penetration is apropos to saving brain tissue.
  • Having soft tissue contrast for preoperative scanning is a clear advantage over flat panel machines.
  • With soft tissue contrast, you can visualize hanging vasculature, create more registration points for your navigation software, and plan the trajectory knowing that the patient and brain have not moved since the scan. Postoperatively, you can check the anatomical location of your DBS leads and whether there was movement when securing them with the burr hole cap.
  • Postoperative imaging also acts as an early safety check for hematoma.
  • Intraoperative imaging is also the gateway for performing DBS surgery under general anesthesia without the use of MER recording.

Deep Brain Stimulation surgery is a growing intervention that has seen widespread adoption over the past 10 years as a standard of care for Parkinson’s disease and essential tremor. Intraoperative imaging with CereTom® point of care CT is changing the landscape of DBS surgery. Whether CereTom® is used with traditional DBS surgery with MER or under general anesthesia without MER, it provides intraoperative safety and accuracy checks that save time and brain.



For further information, below is a list of studies, white papers, videos and published literature utilizing intraoperative portable CT for deep brain stimulation

DBS CASE STUDY

To read case study: click here

DBS WHITE PAPER

To read white paper: click here

FEATURED VIDEOS

Deep Brain Stimulation and the CereTom CT Scanner

Dr. Kim Burchiel, Oregon Health & Science University To watch video click here

CereTom Assisted Deep Brain Stimulation (DBS)

Dr. Stephen E. Griffith, St. Luke’s Marion Bloch Neuroscience Institute To watch video click here

RESEARCH

CereTom DBS

  • Burchiel, K.J., et al. (2013) “Accuracy of deep brain stimulation electrode placement using intraoperative computed tomography without microelectrode recordin”, Journal of Neurosurgery, 119(2), 301–306; Available from: http://doi.org/10.3171/2013.4.JNS122324

  • Mirzadeh, Z., et al. (2014) “Validation of CT-MRI fusion for intraoperative assessment of stereotactic accuracy in DBS surgery”, Movement Disorders, 29(14), 1788–1795; Available from: http://doi.org/10.1002/mds.26056

  • Mirzadeh Z., et al. (2015) “Parkinson’s Disease Outcomes after intraoperative CT-guided “asleep” deep brain stimulation in the globus pallidus”, Journal of Neurosurgy, Available from: http://www.ncbi.nlm.nih.gov/pubmed/26452116

  • Pezeshkian, P., et al. (2011) “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”, Neurosurgery, 69(6), 1299–1306; Available from: http://doi.org/10.1227/NEU.0b013e31822b7069

  • Harries AM, et al. (2012) “Deep brain stimulation of the subthalamic nucleus for advanced Parksinson’s disease using general anesthesia: long term results” Journal of Neurosurgery 116(1); 107-113. Available at: http://www.ncbi.nlm.nih.gov/pubmed/21999316

BodyTom DBS

    • Gill, A.S., et al. (2014) “Validation of Intraoperative 32-slice computed tomography as a useful adjunct to MR and MER-guided DBS Implantation in STN-Targeted Parkinson’s Disease: Existing Prospects on the Horizon”, Stereotact Funct Neurosurg, 92(suppl 1), #234 – Poster presentation; Available from: https://www.karger.com/Journal/Issue/261371

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