Minimizing Hemorrhage Complications in Deep Brain Stimulation Surgery - The Impact of Imaging Modalities and Trajectory Planning

Hong, Seung Woo; Phuong, Dao Duy; Chang, Kyung Won; Jung, Hyun Ho; Chang, Jin Woo

doi:.0..

Journal of Korean Neurosurgical Society > Accepted Articles

Clinical Article

doi: https://doi.org/10.3340/jkns.2024.0198 [Accepted]

Minimizing Hemorrhage Complications in Deep Brain Stimulation Surgery - The Impact of Imaging Modalities and Trajectory Planning

¹Department of Neurosurgery, Hanyang University Seoul Hospital, Seoul, Korea
²Department of Neurosurgery, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
³Department of Neurosurgery, Samsung Medical Center, Seoul, Korea
⁴Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea
⁵Department of Neurosurgery, Korea University Anam Hospital, Seoul, Korea

Correspondence

Jin Woo Chang ,Tel: +82-2-2286-1125, Fax: +82-2-920-6910, Email: jchang@kumc.or.kr

Received: October 30, 2024; Revised: January 21, 2025 Accepted: February 12, 2025. Published online: February 17, 2025.

ABSTRACT

Objective
: This retrospective study aims to analyze hemorrhage complications in patients undergoing deep brain stimulation (DBS) surgery, focusing on the impact of imaging modalities and trajectory planning.
Methods
: We conducted a retrospective review of patients who underwent DBS at a single institution from September 2018 to February 2023. Surgical planning data were analyzed using a combination of 1.5 Tesla(T) and 3.0 T Magnetic resonance image (MRI) for trajectory planning. Trajectories were classified into four types (Type 1–4) based on the proximity of vascular structures within 2 mm on preoperative MRI scans, as defined in this study. Hemorrhage presence was evaluated through postoperative computed tomography (CT) scans.
Results
: Out of 200 patients analyzed, Type 1 trajectories (no vascular structures within 2 mm on both MRIs) accounted for 72.70% of cases with the lowest hemorrhage rate. Significant differences in hemorrhage rates were observed among the types, with higher risks associated with Type 4 trajectories. Additionally, significant variations in vascular structure types were noted across DBS targets, with STN showing the highest risk.
Conclusion
: Meticulous trajectory planning using both 1.5T and 3.0T MRI is crucial in minimizing hemorrhagic complications in DBS. The study underscores the need for precise imaging and planning to enhance patient safety and surgical outcomes.

Key Words: Deep brain stimulation · Hemorrhage complications · Trajectory design