Abstract
Directional deep brain stimulation (dDBS) electrodes allow to steer the electrical field in a specific direction. When implanted with torque, they may rotate for a certain time after implantation. The aim of this study was to evaluate whether and to which degree leads rotate in the first 24 h after implantation using a sheep brain model. dDBS electrodes were implanted in 14 sheep heads and 3D rotational fluoroscopy (3D-RF) scans were acquired to visualize the orientation of the electrode leads. Electrode leads were clockwise rotated just above the burr holes (180° n = 6, 360° n = 6, 2 controls) and 3D-RF scans were again acquired after 3, 6, 13, 17, and 24 h, respectively. One hundred eighty degree rotated electrodes showed an initial rotation of 83.5° (range: 35.4°–128.3°) and a rotation of 114.0° (range: 57°–162°) after 24 h. With 360° torsion, mean initial rotation was 201° (range: 3.3°–321.4°) and mean rotation after 24 h 215.7° (range 31.9°–334.7°), respectively. Direct postoperative imaging may not be accurate for determining the rotation of dDBS electrodes if torque is present.
Highlights
Deep brain stimulation (DBS) is a well-established treatment for several disorders such as Parkinson’s disease, tremor, dystonia, and drug-resistant epilepsy
Stereotactic x-ray, and recently 3D rotational fluoroscopy (3D-RF) are accurate imaging modalities to determine the rotation of directional DBS electrodes (dDBS) [3,4,5,6]
Afterwards, the fixation at the skull level was carefully released and the dDBS was rotated at the skull level by either 180° (n = 6) or 360° (n = 6) and the extracranial part was permanently fixed to the skull using the same technique, immediately after a second 3D-RF run was acquired
Summary
Deep brain stimulation (DBS) is a well-established treatment for several disorders such as Parkinson’s disease, tremor, dystonia, and drug-resistant epilepsy. The latest generation of the so-called directional DBS electrodes (dDBS) contains multiple electrode contacts and allows to distribute the stimulation field between the lead segments, steering the electrical field in a pre-defined direction. This helps to avoid or reduce inadvertent events by stimulation of adjacent brain regions. Stereotactic x-ray, and recently 3D rotational fluoroscopy (3D-RF) are accurate imaging modalities to determine the rotation of dDBS [3,4,5,6] They are considered to be very precise (deviation from true orientation: rotational fluoroscopy ± 2.44°; CT − 0.6 ± 1.5° (range: − 5.4 to 4.2°); flat-panel CT 5.4° ± 4.1° (range: 0.4°–11.9°); stereotactic x-ray 0.0° ± 5.0° (range: − 12° to 14°))
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