Session Time: 1:45pm-3:15pm
Location: Exhibit Hall C
Objective: To investigate the cause and to minimize the lead location displacement after DBS implantation
Background: Precise targeting is the key towards successful deep brain stimulation (DBS). Post-implantation lead displacement could be more than 7mm from the literature. Various factor have been identified including brain shift, intracranial air, CSF loss and anchoring methods.
Methods: The patient was in supine position. Fibrin glue was applied immediately to the burr hole once the cannula was inserted. The right side was performed first followed by the left side in one operation. The 1st poet-operative CT was done in the same day of the operation (within 12 hours). The 2nd CT was done => one month after the operation. Both CT images were co-registered using a stereotactic software (BrainLAB, Feldkirchen, Germany). The most distal contact was used for comparison of the X, Y and Z coordinates in reference to mid-ACPC line. The tract were also compared for any displacement. Intracranial air volume in the 1st CT was calculated using the same software.
Results: From 2010 to early 2016, there were 11 cases with Parkinson’s disease undergone bilateral DBS with both early and late CT done (10 STN and 1 GPi). The mean age was 59 (SD 8, median 60, range 41-72). The mean interval between the early and late CT was 14 (SD 16, median 12, range 2-55) months.
Intracranial air: Left side mean volume 3.97ml (SD 6.6, median 0.28, range 0-18.2); Right side mean volume 0.45ml (SD 0.72, median 0, range 0-1.85), (p=0.096).
Absolute X, Y and Z displacement of the distal contact: Left side mean 0.64m (SD 0.4); Right side mean 0.46 mm (SD 0.4), (p=0.080). The displacement were <1mm in 6 cases, >1 <1.5mm in 3 cases and >1.5 <2mm in 2 cases. Direction of the displacement were mainly towards anterior and inferior.
Conclusions: Intracranial air is the key factor for lead displacement. In this study, the intracranial volume and distal contact displacement are right more than left side. It is related to the sequence of the procedure. The intracranial air mean volume were right side 0.45ml left 3.96ml in our study. Within this range, the distal contact mean absolute displacement is mostly within 1.5mm and none more than 2mm. The results are favourable comparing with the results from the literature.
To cite this abstract in AMA style:X.-L. Zhu, C. Lau, C.-M. Cheung, D. Chan, A. Chan, V. Mok, J. Yeung, W. Poon. Displacement of deep brain stimulation (DBS) lead location after implantation: Preliminary result of a study comparing early Vs late CT findings [abstract]. Mov Disord. 2017; 32 (suppl 2). https://www.mdsabstracts.org/abstract/displacement-of-deep-brain-stimulation-dbs-lead-location-after-implantation-preliminary-result-of-a-study-comparing-early-vs-late-ct-findings/. Accessed December 2, 2023.
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