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Pneumocephalus in subthalamic deep brain stimulation for Parkinson's disease: a comparison of two different surgical techniques considering factors conditioning brain shift and target precision.
- Source :
- Acta Neurochirurgica; 2021, Vol. 163 Issue 1, p169-175, 7p
- Publication Year :
- 2021
-
Abstract
- Background: Precise placement of electrodes in deep brain stimulation (DBS) may be influenced by brain shift caused by cerebrospinal fluid leaking or air inflow. We compared accuracy and treatment outcomes between a standard technique and one aiming at reducing brain shift. Methods: We retrospectively reviewed 46 patients (92 targets) treated with bilateral subthalamic-DBS for Parkinson's disease. The patients were divided into two groups: group A surgery was performed in supine position with standard burr hole, dural opening, fibrin glue and gelfoam plugging. Group B patients were operated in a semi-sitting position with direct dural puncture to reduce CSF loss. We analysed target deviation on head CT performed immediately after surgery and at 1 month merged with preoperative MRI planning. We recorded pneumocephalus volume, brain atrophy and target correction by intraoperative neurophysiology (ION). Results: In group A, the mean pneumocephalus volume was 10.55 cm<superscript>3</superscript>, mean brain volume 1116 cm<superscript>3</superscript>, mean target deviation 1.09 mm and ION corrected 70% of targets. In group B, mean pneumocephalus was 7.60 cm<superscript>3</superscript> (p = 0.3048), mean brain volume 1132 cm<superscript>3</superscript> (p = 0.6526), mean target deviation 0.64 mm (p = 0.0074) and ION corrected 50% of targets (p = 0.4886). Most leads' deviations realigned to the planned target after pneumocephalus reabsorbtion suggesting a deviation caused by displacement of anatomical structures due to brain shift. Definitive lead position was always decided with ION. Conclusions: The modified DBS technique significantly reduced errors of electrode placement, though such difference was clinically irrelevant. ION corrected a high amount of trajectories in both groups (70% vs 50%). The choice of either strategy is acceptable. [ABSTRACT FROM AUTHOR]
Details
- Language :
- English
- ISSN :
- 00016268
- Volume :
- 163
- Issue :
- 1
- Database :
- Complementary Index
- Journal :
- Acta Neurochirurgica
- Publication Type :
- Academic Journal
- Accession number :
- 147889282
- Full Text :
- https://doi.org/10.1007/s00701-020-04635-9