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Updated: Jul 6, 2025
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Published on: February 15, 2014
Day one postoperative MRI findings following electrode placement for deep brain stimulation: analysis of a large case
Benjamin S Succop1, Carlos Zamora2, Daniel Alberto Roque3
1School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
Objective:
This study sought to characterize postoperative day one MRI findings in deep brain stimulation (DBS) patients.
Methods:
DBS patients were identified by CPT and had their reviewed by a trained neuroradiologist and neurosurgeon blinded to MR sequence and patient information. The radiographic abnormalities of interest were track microhemorrhage, pneumocephalus, hematomas, and edema, and the occurrence of these findings in compare the detection of these complications between T1/T2 gradient-echo (GRE) and T1/T2 fluid-attenuated inversion recovery (FLAIR) magnetic resonance (MR) sequences was compared. The presence, size, and association of susceptibility artifact with other radiographic abnormalities was also described. Lastly, the association of multiple microelectrode cannula passes with each radiographic finding was evaluated. Ad-hoc investigation evaluated hemisphere-specific associations. Multiple logistic regression with Bonferroni correction (corrected p = 0.006) was used for all analysis.
Results:
Out of 198 DBS patients reviewed, 115 (58%) patients showed entry microhemorrhage; 77 (39%) track microhemorrhage; 44 (22%) edema; 69 (35%) pneumocephalus; and 12 (6%) intracranial hematoma. T2 GRE was better for detecting microhemorrhage (OR = 14.82, p < 0.0001 for entry site and OR = 4.03, p < 0.0001 for track) and pneumocephalus (OR = 11.86, p < 0.0001), while T2 FLAIR was better at detecting edema (OR = 123.6, p < 0.0001). The relatively common findings of microhemorrhage and edema were best visualized by T2 GRE and T2 FLAIR sequences, respectively. More passes intraoperatively was associated with detection of ipsilateral track microhemorrhage (OR = 7.151, p < 0.0001 left; OR = 8.953, p < 0.0001 right). Susceptibility artifact surrounding electrodes possibly interfered with further detection of ipsilateral edema (OR = 4.323, p = 0.0025 left hemisphere only).
Discussion:
Day one postoperative magnetic resonance imaging (MRI) for DBS patients can be used to detect numerous radiographic abnormalities not identifiable on a computed tomographic (CT) scan. For this cohort, multiple stimulating cannula passes intraoperatively was associated with increased microhemorrhage along the electrode track. Further studies should be performed to evaluate the clinical relevance of these observations.
Insights
Postoperative day one MRI in deep brain stimulation (DBS) patients reveals common microhemorrhage and edema. Multiple cannula passes correlate with increased microhemorrhage, highlighting MRI
Area of Science:
- Neurosurgery
- Radiology
- Medical Imaging
Background:
- Deep brain stimulation (DBS) is a therapeutic intervention requiring precise electrode placement.
- Postoperative imaging is crucial for assessing potential complications and confirming lead integrity.
Purpose of the Study:
- To characterize day one postoperative MRI findings in patients undergoing deep brain stimulation (DBS).
- To compare the efficacy of T1/T2 gradient-echo (GRE) and T1/T2 fluid-attenuated inversion recovery (FLAIR) sequences in detecting complications.
- To evaluate the association between intraoperative factors and radiographic abnormalities.
Main Methods:
- Retrospective review of 198 DBS patients' postoperative day one MRI scans.
- Radiographic abnormalities including microhemorrhage, pneumocephalus, hematomas, and edema were assessed.
- Comparison of T2 GRE and T2 FLAIR sequences for complication detection; logistic regression analysis was employed.
Main Results:
- Microhemorrhage (entry and track), edema, and pneumocephalus were common findings.
- T2 GRE sequences demonstrated superior detection of microhemorrhage and pneumocephalus.
- T2 FLAIR sequences were more effective for detecting edema; increased cannula passes correlated with track microhemorrhage.
Conclusions:
- Day one postoperative MRI is valuable for detecting abnormalities not visible on CT scans.
- Multiple intraoperative cannula passes are associated with increased electrode track microhemorrhage.
- Further research is needed to determine the clinical significance of these MRI findings.
