Preventing Shift from Pneumocephalus During Deep Brain Stimulation Surgery: Don’t Give Up the ‘Fork in the Brain’

IF 2.5 Q2 CLINICAL NEUROLOGY Tremor and Other Hyperkinetic Movements Pub Date : 2024-04-10 DOI:10.5334/tohm.873
A. Martinez-Nunez, J. Wong, J. Hilliard, K. Foote, Michael S. Okun
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Abstract

Clinical vignette: We present the case of a patient who developed intra-operative pneumocephalus during left globus pallidus internus deep brain stimulation (DBS) placement for Parkinson’s disease (PD). Microelectrode recording (MER) revealed that we were anterior and lateral to the intended target. Clinical dilemma: Clinically, we suspected brain shift from pneumocephalus. Removal of the guide-tube for readjustment of the brain target would have resulted in the introduction of movement resulting from brain shift and from displacement from the planned trajectory. Clinical solution: We elected to leave the guide-tube cannula in place and to pass the final DBS lead into a channel that was located posterior-medially from the center microelectrode pass. Gap in knowledge: Surgical techniques which can be employed to minimize brain shift in the operating room setting are critical for reduction in variation of the final DBS lead placement. Pneumocephalus after dural opening is one potential cause of brain shift. The recognition that the removal of a guide-tube cannula could worsen brain shift creates an opportunity for an intraoperative team to maintain the advantage of the ‘fork’ in the brain provided by the initial procedure’s requirement of guide-tube placement.
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防止深部脑刺激手术中的气胸转移:不要放弃 "大脑中的叉子
临床小故事:我们介绍了一例因帕金森病(Parkinson's disease,PD)而接受左侧苍白球内侧深部脑刺激(DBS)置入术的患者术中出现气胸的病例。微电极记录(MER)显示我们在预定目标的前方和外侧。临床困境:临床上,我们怀疑是气胸引起的脑转移。移除导管以重新调整脑部目标会导致脑部偏移和偏离计划轨迹。临床解决方案:我们选择保留导管插管,并将最终的 DBS 导联导入位于中心微电极通路中后部的通道。知识空白:在手术室环境中采用手术技术最大限度地减少脑偏移对于减少最终 DBS 导联位置的变化至关重要。硬脑膜开口后的气胸是导致脑偏移的潜在原因之一。认识到移除导管插管可能会加重脑偏移,这为术中团队创造了一个机会,以保持初始手术要求放置导管所提供的大脑 "叉 "的优势。
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来源期刊
CiteScore
4.00
自引率
4.50%
发文量
31
审稿时长
6 weeks
期刊最新文献
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