Investigation of Electrode Shift After Anterior Thalamic Nucleus Deep Brain Simulation
Abstract number :
2.47
Submission category :
9. Surgery / 9C. All Ages
Year :
2024
Submission ID :
483
Source :
www.aesnet.org
Presentation date :
12/8/2024 12:00:00 AM
Published date :
Authors :
Presenting Author: Masaki Izumi, MD, PhD – Center of Epilepsy and Functional Neurology, Seirei Hamamatsu General Hospital
Hajime Nakamura, MD – Center of Epilepsy and Functional Neurology, Seirei Hamamatsu General Hospital
Yoshinori Omori, MD, PhD – Center of Epilepsy and Functional Neurology, Seirei Hamamatsu General Hospital
Ayataka Fujimoto, MD.PhD. – Seirei Hamamatsu General Hospital
Rationale: The therapeutic effect of bilateral anterior thalamic nucleus deep brain stimulation (ATN-DBS) for drug-resistant focal epilepsy has been reported previously and has been covered by insurance in Japan since 2023. The representative electrode insertion route is the transventricular approach, which was unprecedented in the past. It has been suggested that planning through the ventricles might result in electrode misalignment and that electrodes might shift after placement. This study aims to measure the postoperative electrode positions over time in our cases and identify long-term trends in electrode positioning.
Methods: This study involved four consecutive patients at our hospital who underwent ATN-DBS for drug-resistant focal epilepsy from April to May 2024. Thin-slice CT scans were taken on postoperative days 1, 3, and 7. These images were fused with preoperative MRI and CT scans using the Cranial Navigation Application (BRAIN LAB). The CT scans were set to bone window settings, and the X, Y, and Z coordinates of the electrode tips were measured on the DICOM images. For each patient, the differences in coordinates between postoperative day 1 and day 3 and between postoperative day 1 and day 7 were measured to examine the trends in these values.
Results: In our four cases, the left electrodes had moved by 0.48 ± 0.35 mm (mean ± standard deviation) to the left, 0.02 ± 0.53 mm anteriorly, and 0.28 ± 0.39 mm caudally on day 3 compared to day 1 postoperatively. Similarly, by day 7, the left electrodes had moved by 0.62 ± 0.46 mm to the left, 0.46 ± 0.69 mm anteriorly, and 0.50 ± 0.45 mm caudally.
For the right electrodes, there was a movement of 0.27 ± 0.53 mm to the right, 0.068 ± 0.43 mm dorsally, and 0.31 ± 0.30 mm caudally on day 3 compared to day 1 postoperatively. Similarly, by day 7, the right electrodes had moved by 0.41 ± 0.60 mm to the right, 0.45 ± 0.32 mm nasally, and 0.50 ± 0.45 mm caudally.
There were no statistically significant differences (t-test) in the changes observed from day 3 to day 7 postoperatively.
Conclusions: Although there were no statistically significant differences, there was an observed tendency for the left electrodes to shift leftward over time and the right electrodes to shift rightward, with both electrodes showing a tendency to move caudally. We will continue to analyze these changes by increasing the number of cases and recording the electrode positions over time.
Funding: The authors did not receive support from any organization for the submitted work.
Surgery