Dang Huy Q, Reyes Gabriel, Devara Ethan, Giridharan Nisha, Allam Anthony K, Banks Garrett P, Viswanathan Ashwin, Shofty Ben, Sheth Sameer A
Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA.
Department of Neurosurgery, University of Utah, Salt Lake City, Utah, USA.
Neurosurg Pract. 2024 Jul 19;5(3):e00087. doi: 10.1227/neuprac.0000000000000102. eCollection 2024 Sep.
Directional deep brain stimulation (DBS) enables treatment optimization by current steering using segmented leads. Identification of the lead's rotational orientation is critical to guide programming decisions. Orientation is often assessed during or immediately after implant, but the degree of lead rotation in the following weeks is not well appreciated. Our objective was to measure the degree of DBS lead rotational orientation changes within the first few weeks after surgery.
We retrospectively reviewed the clinical records of patients who were implanted with segmented DBS leads at our institution. All included patients had at least 1 immediate postoperative computed tomography (CT) (CT1) and another CT at least 1 week later (CT2). We assessed lead rotational orientation angles on CT1 and CT2 and calculated the degrees of rotation change between the scans. We also assessed for any effect of the time interval between scans by calculating the correlation between CT1-CT2 latency and degrees of lead rotation.
We assessed a total of 75 DBS lead orientations for 38 patients. The average change in lead orientation between CT1 and CT2 was 8.6° (median = 2.9°, range = 0.11-168.2°). Only 8 percent of patients (3/38) were found to have a significant change in orientation (>30°); however, when it occurred, it occurred bilaterally. There was no correlation between CT1-CT2 latency and lead rotation (r(74) = 0.04, = .73).
Our study finds that changes in lead orientation occurring over the first few weeks after surgery are rare. Thus, for most patients, the immediate postoperative CT is adequate for determining the orientation angles for clinical programming. However, if programming is found to be difficult, a repeat CT scan could be beneficial for a minority of patients.
定向深部脑刺激（DBS）可通过使用分段电极进行电流控制来优化治疗。确定电极的旋转方向对于指导编程决策至关重要。通常在植入过程中或植入后立即评估方向，但接下来几周内电极的旋转程度尚未得到充分认识。我们的目的是测量手术后最初几周内DBS电极旋转方向的变化程度。
我们回顾性分析了在我们机构植入分段DBS电极的患者的临床记录。所有纳入患者至少有1次术后即刻计算机断层扫描（CT）（CT1），以及至少1周后的另一次CT（CT2）。我们在CT1和CT2上评估电极旋转方向角度，并计算扫描之间的旋转变化程度。我们还通过计算CT1 - CT2间隔时间与电极旋转程度之间的相关性，评估扫描间隔时间的任何影响。
我们共评估了38例患者的75个DBS电极方向。CT1和CT2之间电极方向的平均变化为8.6°（中位数 = 2.9°，范围 = 0.11 -
168.2°）。仅8%的患者（3/38）被发现方向有显著变化（>30°）；然而，当这种情况发生时，是双侧发生的。CT1 - CT2间隔时间与电极旋转之间无相关性（r(74) = 0.04，P = .73）。
我们的研究发现，手术后最初几周内电极方向的变化很少见。因此，对于大多数患者，术后即刻CT足以确定临床编程的方向角度。然而，如果发现编程困难，重复CT扫描可能对少数患者有益。
