Do directional deep brain stimulation leads rotate after implantation?
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ORIGINAL ARTICLE - FUNCTIONAL NEUROSURGERY - OTHER
Do directional deep brain stimulation leads rotate after implantation? Marie T. Krüger 1,2 & Yashar Naseri 1,3 & Fabian Cavalloni 1 & Peter C. Reinacher 2,4 & Georg Kägi 5 & Johannes Weber 6 & Deborah Brogle 1,5 & Oliver Bozinov 1 & Stefan Hägele-Link 5 & Florian Brugger 5 Received: 13 July 2020 / Accepted: 2 September 2020 # Springer-Verlag GmbH Austria, part of Springer Nature 2020
Abstract Background The two middle contacts of directional leads (d-leads) for deep brain stimulation are split into three segments, allowing current steering toward desired axial directions. To facilitate programming, their final orientation needs to be reliably determined. However, it is currently unclear whether d-leads rotate after implantation. Our objective was to assess the degree of d-lead rotation after implantation. Methods We retrospectively analyzed d-lead orientation on intraoperative X-rays, postoperative CT scans (latencies to surgery: 108– 189 min postoperatively), and rotational fluoroscopies (4–9 days postoperatively) for a consecutive series of 32 implanted d-leads. For five d-leads, a CT scan with a mean follow-up of 57 days (range 28–182) was available. All d-leads were implanted with the marker facing anterior and the intention to hit an “iron sight” (ISi) on the X-ray, indicating anterior orientation (i.e., 0° ± 6°). Results In nine d-leads, an ISi was visible on the final X-ray; median orientation was 1.5° (range 0.5–6.0°) at the first follow-up CT, confirming anterior orientation. In d-leads without ISi or where ISi was not evaluable, the median rotation was 15.5° (9.5– 35.0°) and 26.5° (5.5-62.0°), respectively. The orientation of the initial CT was comparable with the orientation determined by the postoperative rotational fluoroscopy and second CT in all d-lead groups. Conclusion D-lead orientation does not change within the first week after implantation. We provide first indications that d-lead orientation remains stable for several weeks after surgery. Determination of lead orientation using marker-based X-ray alone seems too imprecise; adding the ISi method can increase determination of intraoperative orientation. Keywords Deep brain stimulation . Directional leads . Iron sights . Rotational fluoroscopy
Introduction Directional leads (d-leads) are a recent advance in deep brain stimulation (DBS). The two middle contact rows of d-leads
are split into three segments, which allow steering of the electrical current into desired axial directions [6]. Recent studies indicate favorable therapeutic effects along with reduced delivery of electrical power to the tissue and lower side-effect
This article is part of the Topical Collection on Functional Neurosurgery– Other Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00701-020-04568-3) contains supplementary material, which is available to authorized users. * Marie T. Krüger [email protected]
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Faculty of Medicine, Department of Neurosurgery, Medical Center—U
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