Wide-bore 1.5 T MRI-guided deep brain stimulation surgery: initial experience and technique comparison

• Neuromodulation in the form of deep brain stimulation (DBS) is an approved therapy for treating movement disorders, such as Parkinson disease (PD), essential tremor, dystonia, and psychiatric disorders.
• Magnetic resonance imaging (MRI)-guided prospective stereotaxy is an emerging surgical implantation technique that is poised to provide a future platform for treatment delivery.
• MRI-guided prospective stereotaxy could help patients avoid awake surgery, minimize time-off medication, minimize brain shift and implant variance, and minimize brain penetrations as a means of reducing hemorrhage risk.
• Team learning and proficiency, as well as optimized technical workflow, may lead to performance increases over time.
• Future MR-guidance systems may allow MRI-scanner coupling to surgical guidance systems to decrease procedure time and improve efficiency and allow novel and dynamic real-time imaging techniques.

ObjectWe report results of the initial experience with magnetic resonance image (MRI)-guided implantation of subthalamic nucleus (STN) deep brain stimulating (DBS) electrodes at the University of Wisconsin after having employed frame-based stereotaxy with previously available MR imaging techniques and microelectrode recording for STN DBS surgeries.MethodsTen patients underwent MRI-guided DBS implantation of 20 electrodes between April 2011 and March 2013. The procedure was performed in a purpose-built intraoperative MRI suite configured specifically to allow MRI-guided DBS, using a wide-bore (70 cm) MRI system. Trajectory guidance was accomplished with commercially available system consisting of an MR-visible skull-mounted aiming device and a software guidance system processing intraoperatively acquired iterative MRI scans.ResultsA total of 10 patients (5 male, 5 female)—representative of the Parkinson Disease (PD) population—were operated on with standard technique and underwent 20 electrode placements under MRI-guided bilateral STN-targeted DBS placement. All patients completed the procedure with electrodes successfully placed in the STN. Procedure time improved with experience.ConclusionOur initial experience confirms the safety of MRI-guided DBS, setting the stage for future investigations combining physiology and MRI guidance. Further follow-up is required to compare the efficacy of the MRI-guided surgery cohort to that of traditional frame-based stereotaxy.