Accuracy of stimulating electrode placement in paediatric pallidal deep brain stimulation for primary and secondary dystonia

BackgroundAccuracy of electrode placement is an important determinant of outcome following deep brain stimulation (DBS) surgery. Data on accuracy of electrode placement into the globus pallidum interna (GPi) in paediatric patients is limited, particularly those with non-primary dystonia who often have smaller GPi. Pallidal DBS is known to be more effective in the treatment of primary dystonia compared with secondary dystonia.ObjectivesWe aimed to determine if accuracy of pallidal electrode placement differed between primary, secondary and NBIA (neuronal degeneration and brain iron accumulation) associated dystonia and how this related to motor outcome following surgery.MethodsA retrospective review of a consecutive cohort of children and young people undergoing DBS surgery in a single centre. Fused in frame preoperative planning magnetic resonance imaging (MRI) and postoperative computed tomography (CT) brain scans were used to determine the accuracy of placement of DBS electrode tip in Leskell stereotactic system compared with the planned target. The differences along X, Y, and Z coordinates were calculated, as was the Euclidean distance of electrode tip from the target. The relationship between proximity to target and change in Burke-Fahn-Marsden Dystonia Rating Scale at 1 year was also measured.ResultsData were collected from 88 electrodes placed in 42 patients (14 primary dystonia, 18 secondary dystonia and 10 NBIA associated dystonia). Median differences between planned target and actual position were: left-side X-axis 1.05 mm, Y-axis 0.85 mm, Z-axis 0.94 mm and Euclidean difference 2.04 mm; right-side X-axis 1.28 mm, Y-axis 0.70 mm, Z-axis 0.70 mm and Euclidean difference 2.45 mm. Accuracy did not differ between left and right-sided electrodes. No difference in accuracy was seen between primary, secondary or NBIA associated dystonia. Dystonia reduction at 1 year post surgery did not appear to relate to proximity of implanted electrode to surgical target across the cohort.ConclusionsAccuracy of surgical placement did not differ between primary, secondary or NBIA associated dystonia. Decreased efficacy of pallidal DBS in secondary and NBIA associated dystonia is unlikely to be related to difficulties in achieving the planned electrode placement.

[1]  Nexframe Frameless Stereotaxy with Multitract Microrecording: Accuracy Evaluated by Frame-Based Stereotactic X-Ray , 2010, Stereotactic and Functional Neurosurgery.

[2]  A. Destée,et al.  Bilateral deep-brain stimulation of the globus pallidus in primary generalized dystonia. , 2005, The New England journal of medicine.

[3]  Wilhelm Eisner,et al.  Accuracy of stereotactic electrode placement in deep brain stimulation by intraoperative computed tomography. , 2008, Parkinsonism & related disorders.

[4]  C. Marsden,et al.  Validity and reliability of a rating scale for the primary torsion dystonias , 1985, Neurology.

[5]  G. Deuschl,et al.  Accuracy and Distortion of Deep Brain Stimulation Electrodes on Postoperative MRI and CT , 2008, Zentralblatt fur Neurochirurgie.

[6]  P. Silburn,et al.  Rapid subthalamic nucleus deep brain stimulation lead placement utilising CT/MRI fusion, microelectrode recording and test stimulation. , 2006, Acta neurochirurgica. Supplement.

[7]  T. Morioka,et al.  Assessment of Contact Location in Subthalamic Stimulation for Parkinson’s Disease by Co-Registration of Computed Tomography Images , 2008, Stereotactic and Functional Neurosurgery.

[8]  Keyoumars Ashkan,et al.  CT/MR Image Fusion in the Postoperative Assessment of Electrodes Implanted for Deep Brain Stimulation , 2009, Stereotactic and Functional Neurosurgery.

[9]  Paul S Larson,et al.  Intraoperative Computed Tomography for Deep Brain Stimulation Surgery: Technique and Accuracy Assessment , 2011, Neurosurgery.

[10]  M. Hariz,et al.  Effect of electrode contact location on clinical efficacy of pallidal deep brain stimulation in primary generalised dystonia , 2007, Journal of Neurology, Neurosurgery, and Psychiatry.

[11]  F. Rivier,et al.  [The varied etiologies of childhood-onset dystonia]. , 2002, Revue neurologique.

[12]  J. Kim,et al.  Bilateral subthalamic deep brain stimulation using single track microelectrode recording , 2011, Acta Neurochirurgica.

[13]  K. Dujardin,et al.  Bilateral pallidal deep brain stimulation for the treatment of patients with dystonia-choreoathetosis cerebral palsy: a prospective pilot study , 2009, The Lancet Neurology.

[14]  S. Hemm,et al.  Electrical stimulation of the globus pallidus internus in patients with primary generalized dystonia: long-term results. , 2004, Journal of neurosurgery.

[15]  Laura Cif,et al.  Comparison of atlas- and magnetic resonance imaging-based stereotactic targeting of the globus pallidus internus in the performance of deep brain stimulation for treatment of dystonia. , 2002, Journal of neurosurgery.

[16]  Vincent Dousset,et al.  Lack of agreement between direct magnetic resonance imaging and statistical determination of a subthalamic target: the role of electrophysiological guidance. , 2002, Journal of neurosurgery.

[17]  H. Bjartmarz,et al.  Comparison of Accuracy and Precision between Frame-Based and Frameless Stereotactic Navigation for Deep Brain Stimulation Electrode Implantation , 2007, Stereotactic and Functional Neurosurgery.

[18]  P. Starr,et al.  Implantation of deep brain stimulators into the subthalamic nucleus: technical approach and magnetic resonance imaging-verified lead locations. , 2002, Journal of neurosurgery.

[19]  Yong Hoon Lim,et al.  Is MRI a reliable tool to locate the electrode after deep brain stimulation surgery? Comparison study of CT and MRI for the localization of electrodes after DBS , 2010, Acta Neurochirurgica.

[20]  J. Lefaucheur,et al.  Assessing Accuracy of the Magnetic Resonance Imaging‐Computed Tomography Fusion Images to Evaluate the Electrode Positions in Subthalamic Nucleus After Deep‐Brain Stimulation , 2010, Neurosurgery.

[21]  P. Ferroli,et al.  A Simple Method to Assess Accuracy of Deep Brain Stimulation Electrode Placement: Pre-Operative Stereotactic CT + Postoperative MR Image Fusion , 2004, Stereotactic and Functional Neurosurgery.

[22]  G. Westby,et al.  Targeting the subthalamic nucleus for deep brain stimulation: technical approach and fusion of pre- and postoperative MR images to define accuracy of lead placement , 2005, Journal of Neurology, Neurosurgery & Psychiatry.

[23]  R A Bakay,et al.  Magnetic resonance imaging-based stereotactic localization of the globus pallidus and subthalamic nucleus. , 1999, Neurosurgery.

[24]  Jean A. Tkach,et al.  Permanent Neurological Deficit Related to Magnetic Resonance Imaging in a Patient with Implanted Deep Brain Stimulation Electrodes for Parkinson’s Disease: Case Report , 2005, Neurosurgery.

[25]  Benoit M. Dawant,et al.  Clinical Accuracy of a Customized Stereotactic Platform for Deep Brain Stimulation after Accounting for Brain Shift , 2010, Stereotactic and Functional Neurosurgery.

[26]  Alessandra Gorgulho,et al.  Accuracy of Frame-Based Stereotactic Magnetic Resonance Imaging vs Frame-Based Stereotactic Head Computed Tomography Fused With Recent Magnetic Resonance Imaging for Postimplantation Deep Brain Stimulator Lead Localization , 2011, Neurosurgery.

[27]  J. Obeso,et al.  Stereotactic targeting of the globus pallidus internus in Parkinson's disease: imaging versus electrophysiological mapping. , 2000, Neurosurgery.

[28]  Philip A. Starr,et al.  Placement of Deep Brain Stimulators into the Subthalamic Nucleus or Globus pallidus internus: Technical Approach , 2003, Stereotactic and Functional Neurosurgery.

[29]  J. Thiran,et al.  Localization of electrodes in the subthalamic nucleus on magnetic resonance imaging. , 2007, Journal of neurosurgery.

[30]  Kathryn Holloway,et al.  Analysis of Stereotactic Accuracy of the Cosman-Robert-Wells Frame and Nexframe Frameless Systems in Deep Brain Stimulation Surgery , 2010, Stereotactic and Functional Neurosurgery.

[31]  S. Hemm,et al.  Deep brain stimulation for dystonia confirming a somatotopic organization in the globus pallidus internus. , 2004, Journal of neurosurgery.

[32]  J. Volkmann,et al.  Deep brain stimulation of the internal globus pallidus in dystonia: target localisation under general anaesthesia , 2009, Acta Neurochirurgica.

[33]  J. Fitzpatrick,et al.  Accuracy of Customized Miniature Stereotactic Platforms , 2005, Stereotactic and Functional Neurosurgery.

[34]  J. Henderson,et al.  Frameless stereotaxy using bone fiducial markers for deep brain stimulation. , 2005, Journal of neurosurgery.

[35]  D. Roberts,et al.  Magnetic resonance imaging versus computed tomography for target localization in functional stereotactic neurosurgery. , 1999, Neurosurgery.

[36]  Patricia Limousin,et al.  Avoiding the ventricle: a simple step to improve accuracy of anatomical targeting during deep brain stimulation. , 2009, Journal of neurosurgery.

[37]  Paul S Larson,et al.  Subthalamic nucleus deep brain stimulator placement using high-field interventional magnetic resonance imaging and a skull-mounted aiming device: technique and application accuracy. , 2010, Journal of neurosurgery.

[38]  Philip A Starr,et al.  Intraoperative neurophysiology in DBS for dystonia , 2011, Movement disorders : official journal of the Movement Disorder Society.

[39]  J. Volkmann,et al.  Pallidal Stimulation for Dystonia , 2004, Neurosurgery.

[40]  Alastair J. Martin,et al.  Placement of deep brain stimulator electrodes using real‐time high‐field interventional magnetic resonance imaging , 2005, Magnetic resonance in medicine.

[41]  Philip A Starr,et al.  Microelectrode-guided implantation of deep brain stimulators into the globus pallidus internus for dystonia: techniques, electrode locations, and outcomes. , 2006, Neurosurgical focus.

[42]  M. Zanca,et al.  Magnetic resonance imaging stereotactic target localization for deep brain stimulation in dystonic children. , 2000, Journal of neurosurgery.

[43]  Jean A. Tkach,et al.  Neurostimulation system used for deep brain stimulation (DBS): MR safety issues and implications of failing to follow safety recommendations. , 2004, Investigative radiology.

[44]  C. Lind,et al.  Accuracy of Postoperative Computed Tomography and Magnetic Resonance Image Fusion for Assessing Deep Brain Stimulation Electrodes , 2011, Neurosurgery.

[45]  W. Hamel,et al.  Documentation of electrode localization , 2002, Movement disorders : official journal of the Movement Disorder Society.

[46]  Jean A. Tkach,et al.  Variability in RF‐induced heating of a deep brain stimulation implant across MR systems , 2006, Journal of magnetic resonance imaging : JMRI.

[47]  Robert E. Gross,et al.  Assessment of Brain Shift Related to Deep Brain Stimulation Surgery , 2007, Stereotactic and Functional Neurosurgery.

[48]  K. Ashkan,et al.  Proportion of life lived with dystonia inversely correlates with response to pallidal deep brain stimulation in both primary and secondary childhood dystonia , 2013, Developmental medicine and child neurology.

[49]  B. Dawant,et al.  Customized, Miniature Rapid-Prototype Stereotactic Frames for Use in Deep Brain Stimulator Surgery: Initial Clinical Methodology and Experience from 263 Patients from 2002 to 2008 , 2010, Stereotactic and Functional Neurosurgery.

[50]  J. Talairach,et al.  Referentially oriented cerebral MRI anatomy : an atlas of stereotaxic anatomical correlations for gray and white matter , 1993 .

[51]  S. Fahn.  Classification of movement disorders , 2011, Movement disorders : official journal of the Movement Disorder Society.

[52]  Matthias Runge,et al.  Multimodal Localization of Electrodes in Deep Brain Stimulation: Comparison of Stereotactic CT and MRI with Teleradiography , 2010, Stereotactic and Functional Neurosurgery.

[53]  A. Lozano,et al.  LOCATION OF ACTIVE CONTACTS IN PATIENTS WITH PRIMARY DYSTONIA TREATED WITH GLOBUS PALLIDUS DEEP BRAIN STIMULATION , 2008, Neurosurgery.

[54]  M. Hariz,et al.  Leksell's posteroventral pallidotomy in the treatment of Parkinson's disease. , 1992, Journal of neurosurgery.

[55]  C. Halpern,et al.  The Effect of Intraventricular Trajectory on Brain Shift in Deep Brain Stimulation , 2011, Stereotactic and Functional Neurosurgery.

[56]  J. Saint-Cyr,et al.  Primary Dystonia Is More Responsive than Secondary Dystonia to Pallidal Interventions: Outcome after Pallidotomy or Pallidal Deep Brain Stimulation , 2004, Neurosurgery.