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Do directional deep brain stimulation leads rotate after implantation?

  • Original Article - Functional Neurosurgery - Other
  • Published:
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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.

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Acknowledgments

We thank Rebecca Kurtev-Rittstieg (Brainlab) for her support regarding technical and software aspects. Editorial assistance was provided by Deborah Nock (Medical WriteAway, Norwich, UK).

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Authors and Affiliations

  1. Department of Neurosurgery, Cantonal Hospital St. Gallen, Rorschacher Str. 95/Haus 04, 9007, St. Gallen, Switzerland

    Marie T. Krüger, Yashar Naseri, Fabian Cavalloni, Deborah Brogle & Oliver Bozinov

  2. Faculty of Medicine, Department of Stereotactic and Functional Neurosurgery, Medical Center—University of Freiburg, Freiburg, Germany

    Marie T. Krüger & Peter C. Reinacher

  3. Faculty of Medicine, Department of Neurosurgery, Medical Center—University of Freiburg, Freiburg, Germany

    Yashar Naseri

  4. Fraunhofer Institute for Laser Technology, Aachen, Germany

    Peter C. Reinacher

  5. Department of Neurology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland

    Georg Kägi, Deborah Brogle, Stefan Hägele-Link & Florian Brugger

  6. Department of Radiology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland

    Johannes Weber

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  1. Marie T. Krüger
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  2. Yashar Naseri
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Contributions

Research project: A. conception, MTK, and PCR; B. organization, MTK, YN, and FB; C. execution, MTK, FC, JW, and YN

Statistical analysis: A. design, FB and MTK; execution, FB, GK, and SHL; B. review and critique, all authors

Manuscript: A. writing of first draft, MTK and FB; B. review and critique, all authors

Images: A. conception and drawings, MTK; B. review and critique, all authors

Corresponding author

Correspondence to Marie T. Krüger.

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Conflict of interest

Related to this work: MTK has received travel funding from Boston Scientific (manufacturer of the electrodes used in this study). She is a consultant for Brainlab (manufacturer of the planning software used in this study). PCR has received occasional honoraria and travel support from Brainlab AG; he is a consultant for Boston Scientific. The companies had no involvements in the collection, analysis, and interpretation of the data nor in writing, editing, or submitting the manuscript.

Unrelated to this work: MTK has received travel funding from Medtronic. FC holds shares in varying amounts of different companies in medically related fields as a private investor (Amyra Biotech AG, Fresenius SE & Co. KGaA). JW has a partnership with Siemens Healthineers and Artis Q. SHL has received travel funding from AbbVie, Switzerland. FB has received a scholarship by the Baasch-Medicus Foundation, Zurich, and a research grant by the KSSG Forschungskommission.

Statement of ethics

The clinical characteristics and scan-related outcome parameters were obtained as part of the patients’ routine care. All data was stored on an in-house database that was approved by the local ethics committee. All patients gave their written informed consent to be included in the database.

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Krüger, M.T., Naseri, Y., Cavalloni, F. et al. Do directional deep brain stimulation leads rotate after implantation?. Acta Neurochir 163, 197–203 (2021). https://doi.org/10.1007/s00701-020-04568-3

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  • DOI: https://doi.org/10.1007/s00701-020-04568-3

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