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

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 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 subthalamic nucleus showing the highest risk. Conclusion : Meticulous trajectory planning using both 1.5 T and 3.0 T 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.