Physical Plasticity of the Brain and Deep Brain Stimulation Lead: Evolution in the First Post-operative Week

Area of Science:

• Neurosurgery
• Medical Imaging
• Biomedical Engineering

Background:

• Deep brain stimulation (DBS) is a crucial therapy for movement and psychiatric disorders.
• Brain shift following surgery can cause post-operative deformation of implanted DBS leads.
• Understanding lead deformation is essential for optimizing DBS therapy efficacy.

Purpose of the Study:

• To quantitatively assess 3-dimensional deep brain stimulation lead deformation in the post-operative period.
• To analyze the temporal and directional patterns of DBS lead deviation after implantation.

Main Methods:

• Utilized preoperative MRI and CT scans, along with post-operative CT scans at multiple time points (immediately, 24-48h, 7 days) in 13 patients.
• Integrated MRI for brain orientation with CT data to precisely track lead trajectories.
• Calculated lead deviation by comparing the actual lead path to a theoretical linear path from entry to target points.

Main Results:

• Observed directional changes in lead deviation over time: rostral in the first 48 hours, shifting to caudal after one week in the sagittal plane.
• Identified a higher likelihood of lateral deviation compared to medial deviation in the coronal plane.
• Documented anterior net movement of the lead center and medial movement of the proximal lead segment within seven days.

Conclusions:

• Deep brain stimulation lead deviation is a common post-operative event occurring within the first week.
• The observed range of lead deviation in this study was considered normative and not associated with adverse clinical effects.
• Further multicenter research is recommended to establish guidelines for DBS lead deformation and its clinical impact.