Evaluation of the Rotational Stability of Directional Deep Brain Stimulation Leads: A Case Series and Systematic Review

Abstract

Background The rotational stability of directional deep brain stimulation leads is a major prerequisite for sustained clinical effects. Data on directional lead stability are limited and controversial.

Methods We aimed to evaluate the long-term rotational stability of directional leads and define confounding factors in our own population and the current literature. We retrospectively evaluated the orientation of directional leads in patients with available postoperative computed tomography (CT; T1; day of surgery) and an additional postoperative image (T2; CT or rotational fluoroscopy) performed more than 7 days after the initial scan. The potential impact of intracranial air was assessed. We also reviewed the literature to define factors impacting stability.

Results Thirty-six leads were evaluated. The mean follow-up between T1 and T2 was 413.3 (7–1,171) days. The difference in rotation between T1 and T2 was 2.444 ± 2.554 degrees (range: 0–9.0 degrees). The volume of intracranial air did not impact the rotation. The literature search identified one factor impacting the stability of directional leads, which is the amount of twist applied at implantation.

Conclusion Directional leads for deep brain stimulation show stable long-term orientation after implantation. Based on our literature review, large amounts of twist during implantation can lead to delayed rotation and should thus be avoided.

Keywords

deep brain stimulation - directional deep brain stimulation - lead orientation - directional lead - lead rotation

Clinical Trial Registration

Full name and URL of the registry is EU Clinical Trials Register (https://www.clinicaltrialsregister.eu).

Registration number of your study is included in the manuscript (swissethics BASEC).

The type of study was retrospective monocenter study.

Publikationsverlauf

Eingereicht: 26. Juni 2022

Angenommen: 28. Oktober 2022

Artikel online veröffentlicht:
13. Oktober 2023

• References

• 1 Contarino MF, Bour LJ, Verhagen R. et al. Directional steering: a novel approach to deep brain stimulation. Neurology 2014; 83 (13) 1163-1169
• 2 Dembek TA, Reker P, Visser-Vandewalle V. et al. Directional DBS increases side-effect thresholds: a prospective, double-blind trial. Mov Disord 2017; 32 (10) 1380-1388
• 3 Pollo C, Kaelin-Lang A, Oertel MF. et al. Directional deep brain stimulation: an intraoperative double-blind pilot study. Brain 2014; 137 (Pt 7): 2015-2026
• 4 Shao MM, Liss A, Park YL. et al. Early experience with new generation deep brain stimulation leads in Parkinson's disease and essential tremor patients. Neuromodulation 2020; 23 (04) 537-542
• 5 Steigerwald F, Müller L, Johannes S, Matthies C, Volkmann J. Directional deep brain stimulation of the subthalamic nucleus: a pilot study using a novel neurostimulation device. Mov Disord 2016; 31 (08) 1240-1243
• 6 Bruno S, Nikolov P, Hartmann CJ. et al. Directional deep brain stimulation of the thalamic ventral intermediate area for essential tremor increases therapeutic window. Neuromodulation 2021; 24 (02) 343-352
• 7 Rebelo P, Green AL, Aziz TZ. et al. Thalamic directional deep brain stimulation for tremor: spend less, get more. Brain Stimul 2018; 11 (03) 600-606
• 8 Steffen JK, Reker P, Mennicken FK. et al. Bipolar directional deep brain stimulation in essential and Parkinsonian tremor. Neuromodulation 2020; 23 (04) 543-549
• 9 Krüger MT, Avecillas-Chasin JM, Tamber MS. et al. Tremor and quality of life in patients with advanced essential tremor before and after replacing their standard deep brain stimulation with a directional system. Neuromodulation 2021; 24 (02) 353-360
• 10 Ten Brinke TR, Odekerken VJJ, Dijk JM, van den Munckhof P, Schuurman PR, de Bie RMA. Directional deep brain stimulation: first experiences in centers across the globe. Brain Stimulat 2018; 11 (04) 949-950
• 11 Dembek TA, Hoevels M, Hellerbach A. et al. Directional DBS leads show large deviations from their intended implantation orientation. Parkinsonism Relat Disord 2019; 67 (00) 117-121
• 12 Dembek TA, Asendorf AL, Wirths J, Barbe MT, Visser-Vandewalle V, Treuer H. Temporal stability of lead orientation in directional deep brain stimulation. Stereotact Funct Neurosurg 2021; 99 (02) 167-170
• 13 Krüger MT, Naseri Y, Cavalloni F. et al. Do directional deep brain stimulation leads rotate after implantation?. Acta Neurochir (Wien) 2021; 163 (01) 197-203
• 14 Rau A, Urbach H, Coenen VA, Egger K, Reinacher PC. Deep brain stimulation electrodes may rotate after implantation-an animal study. Neurosurg Rev 2021; 44 (04) 2349-2353
• 15 Reinacher PC, Krüger MT, Coenen VA. et al. Determining the orientation of directional deep brain stimulation electrodes using 3D rotational fluoroscopy. AJNR Am J Neuroradiol 2017; 38 (06) 1111-1116
• 16 Krüger MT, Kurtev-Rittstieg R, Kägi G, Naseri Y, Hägele-Link S, Brugger F. Evaluation of automatic segmentation of thalamic nuclei through clinical effects using directional deep brain stimulation leads: a technical note. Brain Sci 2020; 10 (09) 642
• 17 Hellerbach A, Dembek TA, Hoevels M. et al. DiODe: directional orientation detection of segmented deep brain stimulation leads: a sequential algorithm based on CT imaging. Stereotact Funct Neurosurg 2018; 96 (05) 335-341
• 18 Hunsche S, Neudorfer C, Majdoub FE, Maarouf M, Sauner D. Determining the rotational orientation of directional deep brain stimulation leads employing flat-panel computed tomography. Oper Neurosurg (Hagerstown) 2019; 16 (04) 465-470
• 19 Sitz A, Hoevels M, Hellerbach A. et al. Determining the orientation angle of directional leads for deep brain stimulation using computed tomography and digital x-ray imaging: A phantom study. Med Phys 2017; 44 (09) 4463-4473
• 20 Dembek TA, Hellerbach A, Jergas H. et al. DiODe v2: unambiguous and fully-automated detection of directional DBS lead orientation. Brain Sci 2021; 11 (11) 1450
• 21 Lange F, Steigerwald F, Engel D. et al. Longitudinal assessment of rotation angles after implantation of directional deep brain stimulation leads. Stereotact Funct Neurosurg 2021; 99 (02) 150-158