Department of Neurology, University Hospital of Magdeburg, Leipziger Straße 44Saxony-Anhalt, 39108, Magdeburg, Germany.
Department of Stereotactic Neurosurgery, University Hospital of Magdeburg, Magdeburg, Germany.
Neurosurg Rev. 2022 Aug;45(4):2975-2982. doi: 10.1007/s10143-022-01801-8. Epub 2022 May 12.
Directional deep brain stimulation (dDBS) provides multiple programming options. Knowledge of the spatial lead orientation is useful for time-efficient programming. Recent studies demonstrated deviations of up to 90° from the intended orientation angle. We examined the deviation of dDBS-lead orientation for leads from two different manufacturers using intraoperative stereotactic (STX) X-ray images. Intraoperative 2D-X-ray images were acquired after implantation of the first lead (TP1) and the second lead (TP2) enabling the estimation of the spatial position of the first lead at TP1 and TP2 and of changes of the orientation for a defined time period. Two investigators retrospectively estimated the orientation of the directional marker for 64 patients. The mean deviation from intended spatial orientation was 40.8° ± 46.1° for all examined leads. The spatial orientation of the first lead did not significantly change within a period of approximately 1 h. The degree of deviation did not differ significantly between two lead manufacturers but depended on the lead fixation technique. Our results showed deviations from the intended orientation angle immediately after the insertion of dDBS leads. The initial spatial orientation remained stable for approximately 1 h and was not caused by technical properties of the implanted lead. Hence, it was most probably the result of unintended mechanical torsion during insertion and/or fixation. Because precise determination of the lead orientation is mandatory for target-oriented dDBS programming, the use of additional imaging suitable for precise 3D visualization of lead contacts and/or the positioning marker is recommended.
立体定向（STX）术中 X 射线引导下双侧脑深部电刺激（DBS）多靶点植入的前瞻性研究
双侧脑深部电刺激（DBS）提供了多种程控选项。了解空间导联的方向对于高效程控非常有用。最近的研究表明，导联的实际方向与预期方向之间存在高达 90°的偏差。我们使用术中立体定向（STX）X 射线图像检查了来自两个不同制造商的 DBS 导联的偏航方向偏差。在植入第一根导联（TP1）和第二根导联（TP2）后获取术中 2D-X 射线图像，从而能够估计第一根导联在 TP1 和 TP2 的空间位置以及在特定时间段内的方向变化。两名研究人员回顾性地估计了 64 名患者的定向标记的方向。所有检查导联的实际空间方向与预期空间方向的平均偏差为 40.8°±46.1°。在大约 1 小时的时间内，第一根导联的空间方向没有明显变化。偏离程度在两个导联制造商之间没有显著差异，但与导联固定技术有关。我们的结果表明，DBS 导联插入后立即出现与预期方向角度的偏差。初始空间方向在大约 1 小时内保持稳定，这不是植入导联的技术特性引起的。因此，最有可能是由于插入和/或固定过程中发生了意外的机械扭转。由于精确确定导联方向是靶向 DBS 程控的必要条件，因此建议使用额外的成像技术，这些技术适合精确可视化导联接触点和/或定位标记。
