Department of Neurosurgery (N.G., M.S., J.B., W.S.K.).
Medical Imaging (M.S., L.M.N., J.B.), University of Arizona School of Medicine, Tucson, Arizona.
AJNR Am J Neuroradiol. 2020 Dec;41(12):2257-2262. doi: 10.3174/ajnr.A6776. Epub 2020 Oct 1.
"Asleep" deep brain stimulation using general anesthesia and intraoperative MR imaging guidance is considered "off-label" use by current FDA guidelines but is widely used in neurosurgical practice, and excellent safety has been demonstrated using first-generation, omnidirectional electrodes. Safety data for second-generation, directional electrodes in the interventional MR imaging environment have not yet been published. Herein, we report 34 cases of asleep deep brain stimulation using second-generation, directional electrodes in an interventional MR imaging suite at a single institution. Procedural complications and imaging data are described. All patients underwent postoperative MR imaging with fully implanted ("internalized") electrodes after scalp closure; 4 patients also underwent MR imaging with "externalized" electrodes before scalp closure. No MR imaging-related complications were observed, and procedural complication rates were comparable to prior series. This suggests that the use of second-generation, directional electrodes in the interventional MR imaging environment appears to be safe when following manufacturer-published imaging guidelines.
在当前的 FDA 指南中，使用全身麻醉和术中磁共振成像引导的“睡眠”深部脑刺激被认为是“超适应证”使用，但在神经外科实践中广泛应用，并且使用第一代全向电极已经证明了其安全性。在介入性磁共振成像环境中使用第二代定向电极的安全性数据尚未公布。在此，我们报告了在单一机构的介入性磁共振成像套件中使用第二代定向电极进行的 34 例睡眠深部脑刺激病例。描述了手术并发症和影像学数据。所有患者在头皮闭合后均进行了完全植入（“内化”）电极的术后磁共振成像；4 例患者还在头皮闭合前进行了“外化”电极的磁共振成像。未观察到与磁共振成像相关的并发症，并且手术并发症发生率与先前的系列相似。这表明，当遵循制造商发布的成像指南时，在介入性磁共振成像环境中使用第二代定向电极似乎是安全的。
