Presentation on theme: "Olivia Huston Kendall Lee MD, PhD Robert Watson MD, PhD"— Presentation transcript:
1Intraoperative MRI Imaging Strategies to Evaluate for Complications during DBS Surgery Olivia HustonKendall Lee MD, PhDRobert Watson MD, PhDMatt Bernstein PhDJohn Huston MDKiaran McGee PhDMayo Clinic Rochester, MN
2Intraoperative 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.
3Intraoperative 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 selectivelyFLAIR and T2 FSE used ……FLAIR – T2 weighted – shows extraaxial hyperacute blood subarachnoid and subduralFSE – Fast Spin Echo
4Intraoperative MRI During DBS Surgery Results Number of Surgeries: 152Subdural Hematomas: 5Subarachnoid Hemorrhages: 3Intraparenchymal Hemorrhage: 1Subarachnoid Air: 4Brain Shift: 144
5Intraoperative MRI During DBS Surgery Subdural Hematoma Number of SDH: 5Average thickness: 5.2 mmRange: 4-8 mm
6Subdural Hematoma A GRE - isointense B MP-RAGE - iso C FLAIR – high signal intensityD CT – high attenuationSubdural Hematoma
7Intraoperative MRI During DBS Surgery Subarachnoid Hemorrhage Number of SAH: 3One patient experienced headache and disorientation requiring 2 additional days of hospitalization. Symptoms cleared prior to discharge.This is the only patient in our study that had acute clinical changes associated with intracranial air or hemorrhage
8Subarachnoid Hemorrhage A – pre operative MP-RAGEB – MPRAGE – iso – CSF displaced by isoC – FRE - isoD – FLAIR – high signal in subarachnoid spaceE – CT – high attenuation in the subarachnoid spaceSubarachnoid Hemorrhage
9Intraoperative MRI During DBS Surgery Intraparenchymal Hemorrhage Number Hemorrhages: 15 x 5 mm
10Intraparenchymal Hemorrhage BC – GRE – slightly high signal compared to the adjacent brain tissueD – FSE – clear high signalE – confirmed on CTIntraparenchymal Hemorrhage
11Intraoperative MRI During DBS Surgery Subarachnoid Air Number of SA Air: 4
12Subarachnoid Air * Left lead replacement surgery A pre-operative – solcus is large b/c of previous surgeryB postop – MP-RAGE – air is replaceing CSF but both are very low signalC – GRE – low signal – mimicks acute bloodD – CT confirms air – low attenuationSubarachnoid Air
13Intraoperative MRI During DBS Surgery Brain Shift Number with Shift: 144Average: 0.6 cmRange: cm
15Intraoperative 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.