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Brain shift during bur hole-based procedures using interventional MRI.

Michael E Ivan1, Jay Yarlagadda, Akriti P Saxena

  • 1Departments of Neurological Surgery and.

Journal of Neurosurgery
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Summary
This summary is machine-generated.

Brain shift during deep brain stimulation (DBS) surgery is unpredictable and can occur even in deep brain structures. This shift may compromise the accuracy of targeting based on preoperative imaging.

Keywords:
AC = anterior commissureDBS = deep brain stimulationGPi = globus pallidus internusPC = posterior commissurePD = Parkinson's diseaseROI = region of interestSTN = subthalamic nucleusVR = Virchow-Robinbrain shiftdeep brain stimulationfunctional neurosurgeryinterventional MRI

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Area of Science:

  • Neurosurgery
  • Medical Imaging
  • Neurology

Background:

  • Minimally invasive brain surgery, including deep brain stimulation (DBS) and stereotactic biopsy, relies on precise targeting.
  • Brain shift, the movement of brain tissue during surgery, is not well understood in these procedures.

Purpose of the Study:

  • To characterize and quantify brain shift during deep brain stimulation (DBS) electrode implantation using interventional MRI.
  • To assess the impact of brain shift on targeting accuracy in minimally invasive neurosurgery.

Main Methods:

  • Serial MRI scans were acquired before, during, and after DBS electrode placement in 44 procedures.
  • Three-dimensional coordinates of superficial and deep brain structures were tracked to calculate shift magnitude, direction, and rate.
  • Measurements were precise to 0.1 mm.

Main Results:

  • Brain shift ranged from 0.0 to 10.1 mm across all brain regions.
  • The frontal lobe exhibited the greatest shift, followed by temporal and occipital lobes.
  • Deep structures, including the anterior/posterior commissures and basal ganglia, also shifted; ipsilateral pallidum/subthalamic shift averaged 0.6 mm (9% > 2 mm).

Conclusions:

  • Brain shift is a continuous and unpredictable phenomenon during DBS procedures.
  • This unpredictable shift can lead to inaccuracies in stereotactic targeting, even for deep brain targets.
  • Interventional imaging is crucial for understanding and potentially mitigating brain shift during neurosurgery.