Do directional deep brain stimulation leads rotate after implantation?

Area of Science:

• Neurosurgery
• Medical Imaging
• Biomedical Engineering

Background:

• Directional leads (d-leads) for deep brain stimulation (DBS) feature segmented contacts for precise current steering.
• Accurate determination of d-lead orientation is crucial for effective DBS programming.
• The potential for post-implantation rotation of d-leads remains an underexplored clinical question.

Purpose of the Study:

• To investigate the degree of d-lead rotation after surgical implantation.
• To assess the stability of d-lead orientation in the early postoperative period.

Main Methods:

• Retrospective analysis of 32 implanted d-leads using intraoperative X-rays, postoperative CT scans, and rotational fluoroscopies.
• Evaluation of d-lead orientation at various time points, including immediate post-op and up to 57 days follow-up.
• Utilized the

Main Results:

• D-lead orientation remained stable within the first week post-implantation.
• Initial CT scans showed comparable orientation to later rotational fluoroscopies and CT scans.
• The "iron sight" (ISi) method, when visible on X-rays, indicated a median orientation of 1.5°, confirming anterior positioning.

Conclusions:

• D-lead orientation is stable in the first week after implantation, with indications of continued stability for several weeks.
• Marker-based X-ray alone is insufficient for precise lead orientation determination.
• Incorporating the ISi method enhances intraoperative assessment of directional lead orientation.