Methodology for MR Guided DBS Implantation Sample Clauses

Methodology for MR Guided DBS Implantation. We utilized the same general principles that had previously been applied to MR guided brain biopsy (28) to develop a prototype system for DBS implantation (29). This approach is performed entirely within the magnet bore and requires a burrhole mounted MR compatible trajectory guide whose orientation can be visualized with MR imaging (Figure 1). An “alignment indicator”, is used to indicate orientation and articulates around a precise point called the “pivot point”. Since the pivot point is fixed, it is important to assure that the burrhole be created in an appropriate location. Thus, an initial contrast enhanced T1-weighted volumetric scan of the brain is performed to reveal cortical surface structure and vessel locations. This data is also used to roughly identify target coordinates based on the relative position of the anterior (AC) and posterior (PC) commissures. A ray is extended from the estimated target position out through the skull, ideally avoiding the lateral ventricle, suici and blood vessels on the cortical surface. The point where this ray exits the skull must then be identified and the burrhole created at this location. We have utilized several methods for identifying this point, including a fluoroscopic MR sequence that is positioned parallel to the skull surface and centered on the ray. The surgeon can probe the skull surface with an MR visible probe while this fluoroscopic sequence is running and identify the desired entry point. The skin is then marked and subsequently the cranial surface is scored at the desired position for the burrhole. For bilateral procedures this will be repeated on the contralateral side. Figure 1: The trajectory guide used in our initial study of MR guided DBS implantations. The plastic burrhole-mounted trajectory guide can be seen on the left with the alignment indicator in place. The corresponding appearance of the alignment indicator on an MR image is shown on the right in an oblique coronal plane. The patient is then moved to the back of the magnet, where a sterile field is established, skin incision is performed, burrholes are created, and trajectory guides are mounted. The patient is then returned to magnet isocenter, where they will remain until the DBS electrode is appropriately positioned. Scanning is initially performed to locate AC-PC and the mid-sagittal plane. A high resolution T2-weighted turbo spin echo sequence is then acquired in an oblique axial plane that is parallel to AC-PC and perpendicular t...
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