Sulcal and ventricular trajectories in stereotactic surgery
W Jeff Elias1, Charles A Sansur, Robert C Frysinger
1Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia 22908, USA. wje4r@virginia.edu
Journal of Neurosurgery
|September 30, 2008
Summary
Deep brain stimulation electrode placement near sulci increases complication risks. Careful planning and MR analysis are crucial for safe electrode trajectories and minimizing cerebrovascular events.
Area of Science:
- Neurosurgery
- Medical Imaging
- Neurology
Background:
- Deep brain stimulation (DBS) is a neurosurgical procedure involving electrode implantation.
- Cerebrovascular complications can arise during DBS electrode placement.
- Understanding trajectory risks is vital for patient safety.
Purpose of the Study:
- To analyze deep brain stimulation electrode trajectories on MR images.
- To identify risks associated with electrode insertions, sulcal traversal, and ventricular penetration.
- To correlate these factors with cerebrovascular complications.
Main Methods:
- Fused pre- and postoperative MR images to assess electrode proximity to sulci and ventricles.
- Classified complications as hemorrhagic/nonhemorrhagic and symptomatic/asymptomatic.
- Analyzed 258 electrode implantations for deep brain stimulation.
Main Results:
- Proximity to a sulcus significantly increased risk for cortical complications (p = 0.001).
- Complication rate was 10.1% for trajectories near sulci versus 0.7% within gyri.
- Asymptomatic intraventricular hemorrhage (IVH) occurred in 5% of ventricular penetrations.
Conclusions:
- Symptomatic cortical complications are linked to electrodes traversing near sulci.
- Asymptomatic IVH is infrequent with ventricular penetration.
- Postoperative analysis revealed a higher incidence of electrode proximity to sulci than expected, emphasizing meticulous trajectory planning and MR review.
