Intraoperative MRI Imaging Strategies
to Evaluate for Complications during
DBS Surgery
Olivia Huston
Kendall Lee MD, PhD
Robert Watson MD, PhD
Matt Bernstein PhD
John Huston MD
Kiaran McGee PhD
Mayo Clinic Rochester, MN
Intraoperative MRI During DBS Surgery
Purpose
To determine the optimal imaging sequences, the
imaging findings and the clinical consequences
of those findings for MRI performed during
DBS surgery.
Intraoperative MRI During DBS Surgery
Methods
•
143 patients underwent 152 DBS surgeries
utilizing intraoperative 1.5T MRI.
•
MRI sequences utilized:
- T1 MP-RAGE pre and intra-op
- T2* GRE intra-op
- T2 FLAIR selectively
- T2 FSE selectively
Intraoperative MRI During DBS Surgery
Results
Number of Surgeries: 152
•
•
•
•
•
Subdural Hematomas: 5
Subarachnoid Hemorrhages: 3
Intraparenchymal Hemorrhage: 1
Subarachnoid Air: 4
Brain Shift: 144
Intraoperative MRI During DBS Surgery
Subdural Hematoma
•
Number of SDH: 5
•
Average thickness: 5.2 mm
•
Range: 4-8 mm
Subdural Hematoma
Intraoperative MRI During DBS Surgery
Subarachnoid Hemorrhage
•
Number of SAH: 3
•
One patient experienced headache
and disorientation requiring 2
additional days of hospitalization.
Symptoms cleared prior to
discharge.
Subarachnoid Hemorrhage
Intraoperative MRI During DBS Surgery
Intraparenchymal Hemorrhage
•
Number Hemorrhages: 1
•
5 x 5 mm
Intraparenchymal Hemorrhage
Intraoperative MRI During DBS Surgery
Subarachnoid Air
•
Number of SA Air: 4
Subarachnoid Air
Intraoperative MRI During DBS Surgery
Brain Shift
•
Number with Shift: 144
•
Average: 0.6 cm
•
Range: 0.1-1.3 cm
Brain Shift
Intraoperative MRI During DBS Surgery
Conclusions
•
Intracranial hemorrhage is occasionally identified but is
rarely clinically significant. One delayed SDH required
evacuation.
•
Brain shift during DBS surgery is common.
•
Subarachnoid air mimics subarachnoid blood on GRE.
•
Selective use of T2 FLAIR and T2 FSE imaging can
confirm the presence hemorrhage or air and precludes
the need for CT exams.