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Olivia Huston Kendall Lee MD, PhD Robert Watson MD, PhD Matt Bernstein PhD John Huston MD Kiaran McGee PhD Intraoperative MRI Imaging Strategies to Evaluate.

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Presentation on theme: "Olivia Huston Kendall Lee MD, PhD Robert Watson MD, PhD Matt Bernstein PhD John Huston MD Kiaran McGee PhD Intraoperative MRI Imaging Strategies to Evaluate."— Presentation transcript:

1 Olivia Huston Kendall Lee MD, PhD Robert Watson MD, PhD Matt Bernstein PhD John Huston MD Kiaran McGee PhD Intraoperative MRI Imaging Strategies to Evaluate for Complications during DBS Surgery Mayo Clinic Rochester, MN

2 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.

3 Intraoperative MRI During DBS Surgery Methods 143 patients underwent 152 DBS surgeries utilizing intraoperative 1.5T MRI. 143 patients underwent 152 DBS surgeries utilizing intraoperative 1.5T MRI. MRI sequences utilized: MRI sequences utilized: - T1 MP-RAGE pre and intra-op - T2* GRE intra-op - T2 FLAIR selectively - T2 FSE selectively

4 Intraoperative MRI During DBS Surgery Results Number of Surgeries: 152 Subdural Hematomas: 5 Subdural Hematomas: 5 Subarachnoid Hemorrhages: 3 Subarachnoid Hemorrhages: 3 Intraparenchymal Hemorrhage: 1 Intraparenchymal Hemorrhage: 1 Subarachnoid Air: 4 Subarachnoid Air: 4 Brain Shift: 144 Brain Shift: 144

5 Intraoperative MRI During DBS Surgery Subdural Hematoma Number of SDH: 5 Number of SDH: 5 Average thickness: 5.2 mm Average thickness: 5.2 mm Range: 4-8 mm Range: 4-8 mm

6 Subdural Hematoma

7 Intraoperative MRI During DBS Surgery Subarachnoid Hemorrhage Number of SAH: 3 Number of SAH: 3 One patient experienced headache and disorientation requiring 2 additional days of hospitalization. Symptoms cleared prior to discharge. One patient experienced headache and disorientation requiring 2 additional days of hospitalization. Symptoms cleared prior to discharge.

8 Subarachnoid Hemorrhage

9 Intraoperative MRI During DBS Surgery Intraparenchymal Hemorrhage Number Hemorrhages: 1 Number Hemorrhages: 1 5 x 5 mm 5 x 5 mm

10 Intraparenchymal Hemorrhage

11 Intraoperative MRI During DBS Surgery Subarachnoid Air Number of SA Air: 4 Number of SA Air: 4

12 Subarachnoid Air

13 Intraoperative MRI During DBS Surgery Brain Shift Number with Shift: 144 Number with Shift: 144 Average: 0.6 cm Average: 0.6 cm Range: cm Range: cm

14 Brain Shift

15 Intraoperative MRI During DBS Surgery Conclusions Intracranial hemorrhage is occasionally identified but is rarely clinically significant. One delayed SDH required evacuation. Intracranial hemorrhage is occasionally identified but is rarely clinically significant. One delayed SDH required evacuation. Brain shift during DBS surgery is common. Brain shift during DBS surgery is common. Subarachnoid air mimics subarachnoid blood on GRE. 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. Selective use of T2 FLAIR and T2 FSE imaging can confirm the presence hemorrhage or air and precludes the need for CT exams.


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