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Computed Tomography Angiography in Surgical Planning for Deep Brain Stimulation Is Associated With Reduced Rates of
Hael Abdulrazeq1,2,3, Tori Riccelli1,2,3, Derrick Chatad1,3,4
1Department of Neurosurgery, Rhode Island Hospital, Brown University Health, Providence, Rhode Island, USA.
Background And Objective:
Deep brain stimulation (DBS) offers surgical treatment for various movement and psychiatric disorders but harbors the risk of hemorrhage. This study examined using MRI plus computed tomography angiography (CTA) vs MRI alone in trajectory planning and its association with hemorrhage rates in DBS procedures.
Methods:
Patients undergoing DBS implantation with MER were assessed from January 2012 to July 2025. Preoperative and postoperative imaging data were analyzed, focusing on the incidence and size of postoperative hemorrhages. Cohorts were compared in which preoperative imaging included MRI with CTA vs MRI alone.
Results:
In total, 197 patients met inclusion criteria. Twelve patients with radiographic tract hemorrhages were identified: 9 were in the non-CTA group, with 5/9 having clinical symptoms attributed to the hemorrhage. Postoperative MRI identified 3 patients in the CTA group with hemorrhage, none of which were symptomatic. To account for differing patient-level vs trajectory-level assumptions about the sources of bleeding, we analyzed hemorrhage rates as a function of patient vs trajectory: the use of CTA for surgical planning was not associated with a significant difference in the rate of hemorrhage at the patient level (P = .468) but was associated with a significant difference in the rate of hemorrhage at the trajectory level (P = .041). In addition, patients in the non-CTA group had significantly increased volume of hemorrhage (mean non-CTA group: 6.9 mL, mean CTA group: 0.6 mL, P-value = .014).
Conclusion:
The use of preoperative CTA for stereotactic planning may be associated with reduced incidence of tract hemorrhage. The relatively low incidence of this surgical complication may have limited this study's ability to detect greater differences between CTA + MRI based vs MRI-alone DBS planning. Larger, prospective studies comparing simultaneous cohorts will be necessary to confirm this potential benefit.
