Brain shift during bur hole–based procedures using interventional MRI

Clinical article

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  • 1 Departments of Neurological Surgery and
  • 4 Radiology, University of California, San Francisco, California;
  • 2 Jefferson Medical College, Philadelphia, Pennsylvania; and
  • 3 Internal Medicine Department, Tufts Medical Center, Boston, Massachusetts

Object

Brain shift during minimally invasive, bur hole–based procedures such as deep brain stimulation (DBS) electrode implantation and stereotactic brain biopsy is not well characterized or understood. We examine shift in various regions of the brain during a novel paradigm of DBS electrode implantation using interventional imaging throughout the procedure with high-field interventional MRI.

Methods

Serial MR images were obtained and analyzed using a 1.5-T magnet prior to, during, and after the placement of DBS electrodes via frontal bur holes in 44 procedures. Three-dimensional coordinates in MR space of unique superficial and deep brain structures were recorded, and the magnitude, direction, and rate of shift were calculated. Measurements were recorded to the nearest 0.1 mm.

Results

Shift ranged from 0.0 to 10.1 mm throughout all structures in the brain. The greatest shift was seen in the frontal lobe, followed by the temporal and occipital lobes. Shift was also observed in deep structures such as the anterior and posterior commissures and basal ganglia; shift in the pallidum and subthalamic region ipsilateral to the bur hole averaged 0.6 mm, with 9% of patients having over 2 mm of shift in deep brain structures. Small amounts of shift were observed during all procedures; however, the initial degree of shift and its direction were unpredictable.

Conclusions

Brain shift is continual and unpredictable and can render traditional stereotactic targeting based on preoperative imaging inaccurate even in deep brain structures such as those used for DBS.

Abbreviations used in this paper:AC = anterior commissure; DBS = deep brain stimulation; GPi = globus pallidus internus; PC = posterior commissure; PD = Parkinson's disease; ROI = region of interest; STN = subthalamic nucleus; VR = Virchow-Robin.

Contributor Notes

Address correspondence to: Michael E. Ivan, M.D., 505 Parnassus Ave., Box 0112, San Francisco, CA 94117. email: ivanm@neurosurg.ucsf.edu.

Please include this information when citing this paper: published online May 2, 2014; DOI: 10.3171/2014.3.JNS121312.

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