Mahvash Mehran, Pechlivanis Ioannis, Charalampaki Patra, Jansen Olav, Mehdorn Hubertus Maximilian
Department of Neurosurgery, Clinic of Köln-Merheim, University of Witten-Herdecke, Köln, Germany.
Department of Neurosurgery, Clinic of Köln-Merheim, University of Witten-Herdecke, Köln, Germany.
Clin Neurol Neurosurg. 2014 Sep;124:151-5. doi: 10.1016/j.clineuro.2014.06.041. Epub 2014 Jul 7.
Intracerebral hemorrhage (ICH) is the most significant complication of Deep Brain Stimulation (DBS). To prevent ICH, stereotactic contrast enhanced T1-weighted images are used to visualize vessels as source of hemorrhage. Susceptibility-Weighted Imaging (SWI) is an MRI sequence with improved visualization of susceptibility differences between tissues, particularly sensitive for brain veins. The aim of this prospective study was to analyze the utility of SWI compared to contrast enhanced stereotactic T1-weighted images for trajectory planning of DBS. Preoperative SWI was performed in 33 patients undergoing DBS and was compared to the T1-weighted images. Vessels identified only with SWI in relation to the bilateral planned trajectory were analyzed. In all patients vessels were depicted on SWI only within the planned trajectory (range 1-4 vessels, for each trajectory, mean: 2.4). In 6 patients vessels were identified on SWI adjacent to the target (up to 5mm distal from target). In 11 patients SWI visualized additional cortical veins adjacent to the entry point of the trajectory. The apparent diameter of these vessels ranged between 0.8 and 2.1mm (mean: 1.2mm). Postoperative MRI was compared with preoperative SWI and revealed in two patients small (<3 mm) T2 hyperintense lesions along electrodes without correlation with visualized veins. SWI facilitates the visualization of small veins superior to T1-weighted images. However, cerebral veins within the trajectory were not found to be a significant source of ICH after DBS. Potential sources of ICH are mesencephal veins at the endpoint of electrodes which can cause fatal hemorrhage and are visualized with SWI reliably.
脑出血（ICH）是深部脑刺激（DBS）最严重的并发症。为预防脑出血，立体定向对比增强T1加权图像用于将血管可视化为出血源。磁敏感加权成像（SWI）是一种磁共振成像序列，能更好地显示组织间的磁敏感差异，对脑静脉尤其敏感。这项前瞻性研究的目的是分析与对比增强立体定向T1加权图像相比，SWI在DBS轨迹规划中的效用。对33例接受DBS的患者进行术前SWI检查，并与T1加权图像进行比较。分析仅在SWI上识别出的与双侧计划轨迹相关的血管。在所有患者中，仅在计划轨迹内的SWI上描绘出血管（每个轨迹范围为1 - 4条血管，平均：2.4条）。在6例患者中，在SWI上识别出与靶点相邻的血管（距靶点远端达5mm）。在11例患者中，SWI显示了与轨迹入口点相邻的额外皮质静脉。这些血管的表观直径在0.8至2.1mm之间（平均：1.2mm）。术后MRI与术前SWI比较，发现2例患者沿电极出现小的（<3mm）T2高信号病变，与可视化静脉无关。与T1加权图像相比，SWI有助于更好地显示小静脉。然而，未发现轨迹内的脑静脉是DBS后脑出血的重要来源。脑出血的潜在来源是电极末端的中脑静脉，可导致致命性出血，且SWI能可靠地显示这些静脉。
