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Minimizing brain shift during functional neurosurgical procedures - a simple burr hole technique that can decrease

V A Coenen¹, A Abdel-Rahman, J McMaster

¹Bonn University, Stereotaxy and MR-based OR Techniques/Neurosurgery, Bonn, Germany. volker.coenen@ukb.uni-bonn.de

Central European Neurosurgery

|July 9, 2011

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A novel burr hole technique significantly reduced postoperative intracranial air and brain shift in deep brain stimulation (DBS) surgery. This simple, cost-effective method improves DBS electrode placement accuracy.

Area of Science:

Neurosurgery
Stereotactic Surgery
Medical Device Technology

Background:

Intraoperative brain shift complicates stereotactic neurosurgery, particularly deep brain stimulation (DBS) electrode placement.
Brain shift is correlated with the volume of intracranial air detected post-surgery.
Reducing intracranial air is crucial for improving surgical accuracy.

Purpose of the Study:

To evaluate a novel burr hole technique designed to minimize cerebrospinal fluid (CSF) loss during functional stereotactic neurosurgery.
To assess the technique's efficacy in reducing postoperative intracranial air and subsequent brain shift.
To determine the potential impact on deep brain stimulation (DBS) electrode placement accuracy.

Main Methods:

A prospective study involving 16 patients undergoing DBS surgery.

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Group 2 (n=8) received a new burr hole technique to seal the CSF space; Group 1 (n=8) received the standard technique.

Early postoperative 3D CT scans were used to quantify intracranial air volume; groups were compared using t-tests.

Main Results:

The novel technique group (Group 2) exhibited significantly lower mean intracranial air volumes (4.86 cc) compared to the standard group (Group 1, 27.59 cc; p=0.0083).
Surgical duration was significantly longer for the standard technique group (435 min) versus the novel technique group (316 min; p=0.00015).
The time between surgery conclusion and CT scanning was comparable between groups.

Conclusions:

The new burr hole technique effectively reduces postoperative intracranial air, a key factor in brain shift.
This straightforward, cost-effective method holds potential for enhancing DBS electrode placement accuracy in seated or half-sitting procedures.
Further investigation with larger, standardized patient series is warranted to validate these findings.