Skip to main content

Perioperative Brain Shift and Deep Brain Stimulating Electrode Deformation Analysis: Implications for rigid and non-rigid devices

Abstract

Deep brain stimulation (DBS) efficacy is related to optimal electrode placement. Several authors have quantified brain shift related to surgical targeting; yet, few reports document and discuss the effects of brain shift after insertion. Objective: To quantify brain shift and electrode displacement after device insertion. Twelve patients were retrospectively reviewed, and one post-operative MRI and one time-delayed CT were obtained for each patient and their implanted electrodes modeled in 3D. Two competing methods were employed to measure the electrode tip location and deviation from the prototypical linear implant after the resolution of acute surgical changes, such as brain shift and pneumocephalus. In the interim between surgery and a pneumocephalus free postoperative scan, electrode deviation was documented in all patients and all electrodes. Significant shift of the electrode tip was identified in rostral, anterior, and medial directions (p < 0.05). Shift was greatest in the rostral direction, measuring an average of 1.41 mm. Brain shift and subsequent electrode displacement occurs in patients after DBS surgery with the reversal of intraoperative brain shift. Rostral displacement is on the order of the height of one DBS contact. Further investigation into the time course of intraoperative brain shift and its potential effects on procedures performed with rigid and non-rigid devices in supine and semi-sitting surgical positions is needed.

This is a preview of subscription content, access via your institution.

Figure 1
Figure 2
Figure 3
Figure 4
Figure 5
Figure 6
Figure 7
Figure 8
Figure 9
Figure 10

References

  1. D’Haese, P. F., S. Pallavaram, et al. Clinical accuracy of a customized stereotactic platform for deep brain stimulation after accounting for brain shift. Stereotact. Funct. Neurosurg. 88(2):81–87, 2010.

    PubMed  Article  Google Scholar 

  2. Deuschl, G., C. Schade-Brittinger, et al. A randomized trial of deep-brain stimulation for Parkinson’s disease. N. Engl. J. Med. 355(9):896–908, 2006.

    PubMed  Article  CAS  Google Scholar 

  3. Goldstein, S. R., and M. Saloman. Mechanical factors in the design of chronic recording intracortical microelectrodes. IEEE Trans. Biomed. Eng. 20(4):260–269, 1973.

    PubMed  Article  CAS  Google Scholar 

  4. Halpern, C. H., S. F. Danish, et al. Brain shift during deep brain stimulation surgery for Parkinson’s disease. Stereotact. Funct. Neurosurg. 86(1):37–43, 2008.

    PubMed  Article  Google Scholar 

  5. Hess, A. E., J. R. Capadona, et al. Development of a stimuli-responsive polymer nanocomposite toward biologically optimized, MEMS-based neural probes. J. Micromech. Microeng. 21(1):1–9, 2011.

    Google Scholar 

  6. Larson, P. S. Deep brain stimulation for psychiatric disorders. Neurotherapeutics 5(1):50–58, 2008.

    PubMed  Article  Google Scholar 

  7. LeWitt, P. A., A. R. Rezai, et al. AAV2-GAD gene therapy for advanced Parkinson’s disease a double-blind, sham-surgery controlled, randomized trial. Lancet Neurol 10(1):309–319, 2011.

    PubMed  Article  CAS  Google Scholar 

  8. Miyagi, Y., F. Shima, et al. Brain shift: an error factor during implantation of deep brain stimulation electrodes. J. Neurosurg. 107(5):989–997, 2007.

    PubMed  Article  Google Scholar 

  9. Papavassiliou, E., G. Rau, et al. Thalamic deep brain stimulation for essential tremor: relation of lead location to outcome. Neurosurgery 54(5):1120–1129, 2004; (discussion 1129-1130).

    PubMed  Article  Google Scholar 

  10. Petersen, E., E. Holl, et al. Minimizing brain shift in stereotactic functional neurosurgery. Neurosurgery 67(3):213–221, 2010.

    Google Scholar 

  11. Richardson, M. R., A. P. Kells, et al. Interventional MRI-guided putaminal delivery of AAV2-GDNF for a planned clinical trial in Parkinson’s disease. Am. Soc. Gene Cell Ther 19(1):1048–1057, 2011.

    Article  CAS  Google Scholar 

  12. Sampson, J. H., G. Archer, et al. Poor drug distribution as a possible explanation for the results of the PRECISE trial. J. Neurosurg. 113(2):301–309, 2010.

    PubMed  Article  Google Scholar 

  13. Sampson, J. H., M. L. Brady, et al. Intracerebral infusate distribution by convection-enhanced delivery in humans with malignant gliomas: descriptive effects of target anatomy and catheter positioning. Neurosurgery 60(2 Suppl 1):ONS89–ONS98, 2007.

    PubMed  Google Scholar 

  14. Starr, P. A. Placement of deep brain stimulators into the subthalamic nucleus or Globus pallidus internus: technical approach. Stereotact. Funct. Neurosurg. 79(3–4):118–145, 2002.

    PubMed  Article  Google Scholar 

  15. Starr, P. A., A. J. Martin, et al. Implantation of deep brain stimulator electrodes using interventional MRI. Neurosurg. Clin. N. Am. 20(2):207–217, 2009.

    Article  Google Scholar 

  16. Subbaroyan, J., D. C. Martin, et al. A finite-element model of the mechanical effects of implantable microelectrodes in the cerebral cortex. J. Neural Eng. 2(1):103–113, 2005.

    PubMed  Article  Google Scholar 

  17. Van den Munckhof, P., M. Fiorella Contarino, et al. Postoperative curving and upward displacement of deep brain stimulation electrodes caused by brain shift. Neurosurgery 67(1):49–54, 2010.

    PubMed  Article  Google Scholar 

Download references

Acknowledgments

The authors would like to thank Heather Rusk, Ethan Brodsky, and Angelica Hinchman of the University of Wisconsin Neurological Surgery Department for their helpful comments on the manuscript. Additionally, we acknowledge Media Solutions, University of Wisconsin for the figure they prepared for this manuscript. This work was supported in part by The Kinetics Foundation and institutional startup funds.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Karl A. Sillay.

Additional information

Associate Editor Jeffrey L. Duerk oversaw the review of this article.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Sillay, K.A., Kumbier, L.M., Ross, C. et al. Perioperative Brain Shift and Deep Brain Stimulating Electrode Deformation Analysis: Implications for rigid and non-rigid devices. Ann Biomed Eng 41, 293–304 (2013). https://doi.org/10.1007/s10439-012-0650-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10439-012-0650-0

Keywords

  • Brain shift
  • Deep brain stimulation (DBS)
  • Electrode displacement
  • Subthalamic nucleus (STN)
  • Parkinson’s disease (PD)
  • Rigid catheter
  • Non-rigid catheter