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Mahlon R. Delong - One of the best experts on this subject based on the ideXlab platform.

  • Clinical Outcomes Of Deep Brain Stimulation Placement Using Intraoperative MRI for Parkinson Disease (P3.359)
    Neurology, 2016
    Co-Authors: Vibhash D. Sharma, Kushal B. Naik, Cathrin M. Buetefisch, Shirley Triche, Jon T. Willie, Nicholas M. Boulis, Stewart A. Factor, Robert E. Gross, Mahlon R. Delong
    Abstract:

    OBJECTIVE: To assess motor outcome in patients with Parkinson disease (PD) who underwent deep brain stimulation (DBS) placement using Intraoperative MRI (ClearPoint®, MRI Interventions). BACKGROUND: DBS lead placement using Intraoperative MRI (iMRI) is an alternative surgical technique utilizing real-time Intraoperative neuroimaging to guide electrode placement. Unlike the traditional awake procedure, iMRI DBS is done under general anesthesia without microelectrode recording (MER) and electrical stimulation. The procedure is beneficial in patients who cannot tolerate or prefer not to undergo an awake procedure. However, there is limited literature on clinical outcomes. METHODS: Forty-one patients with PD who underwent iMRI DBS placement were identified. Of these, patients who also had placement using MER (revision = 1, additional lead = 4) and those with pre-DBS OFF-medication UPDRS part III scores

  • Deep Brain Stimulation Placement Using Intraoperative MRI for Dystonia: One Year Clinical Outcomes (S30.003)
    Neurology, 2016
    Co-Authors: Vibhash D. Sharma, Kushal B. Naik, Cathrin M. Buetefisch, Shirley Triche, Jon T. Willie, Nicholas M. Boulis, Stewart A. Factor, Robert E. Gross, Mahlon R. Delong
    Abstract:

    OBJECTIVE: To evaluate clinical outcome in patients with dystonia who underwent deep brain stimulation (DBS) placement using Intraoperative MRI (ClearPoint®, MRI interventions). BACKGROUND: DBS lead placement using Intraoperative MRI (iMRI) is an alternative surgical technique utilizing real-time Intraoperative neuroimaging to guide electrode placement. Unlike the traditional awake procedure, iMRI DBS is done under general anesthesia without microelectrode recording (MER) and electrical stimulation. However, there is limited literature on clinical outcomes. METHODS: Twenty-two consecutive dystonia patients underwent DBS surgery using iMRI. Of these, 13 patients (idiopathic, n=11; genetic, n=1, tardive n=1) were included in our analysis. Patients with secondary dystonia (n=7) and those with prior DBS placement using MER (n=2) were excluded. Pre- and post-DBS Burke-Fahn-Marsden dystonia rating scale (BFMDRS) movement scores and Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) severity scores were obtained at 6 and 12 months. RESULTS: The mean age of patients (M=6, F=7) was 55 years. Distribution of dystonia was variable with cervical dystonia as predominant component in 12 patients. All patients underwent bilateral GPi DBS placement. The mean BFMDRS and TWSTRS scores before DBS were 20 (95[percnt] CI: 12-28[percnt]) and 17.5 (95[percnt] CI: 14.7-20.2[percnt]) respectively and after DBS were 4.92 (95[percnt] CI: 3.2-6.7[percnt]) and 8.2 (95[percnt] CI: 4-12.5[percnt]) respectively at 12 months. There was a mean improvement in BFMDRS of 70.7[percnt] (95[percnt] CI: 63.8-79.5[percnt], p

  • clinical outcomes of deep brain stimulation placement using Intraoperative MRI for parkinson disease p3 359
    Neurology, 2016
    Co-Authors: Vibhash D. Sharma, Kushal B. Naik, Cathrin M. Buetefisch, Shirley Triche, Jon T. Willie, Nicholas M. Boulis, Stewart A. Factor, Robert E. Gross, Mahlon R. Delong
    Abstract:

    OBJECTIVE: To assess motor outcome in patients with Parkinson disease (PD) who underwent deep brain stimulation (DBS) placement using Intraoperative MRI (ClearPoint®, MRI Interventions). BACKGROUND: DBS lead placement using Intraoperative MRI (iMRI) is an alternative surgical technique utilizing real-time Intraoperative neuroimaging to guide electrode placement. Unlike the traditional awake procedure, iMRI DBS is done under general anesthesia without microelectrode recording (MER) and electrical stimulation. The procedure is beneficial in patients who cannot tolerate or prefer not to undergo an awake procedure. However, there is limited literature on clinical outcomes. METHODS: Forty-one patients with PD who underwent iMRI DBS placement were identified. Of these, patients who also had placement using MER (revision = 1, additional lead = 4) and those with pre-DBS OFF-medication UPDRS part III scores <=15 (n=3) were excluded. Pre- and post- DBS UPDRS Part III scores were obtained at 6 and 12 months. RESULTS: The mean age of patients (M=23, F=10) was 63.8 years. Out of 33 patients, 26 had bilateral (GPi=23, STN=3) and 7 had unilateral (GPi=6, STN=1) implants. Before DBS, the mean improvement in UPDRS Part III score ON-medication was 59.6[percnt] (95[percnt] CI: 53.5-65.8[percnt]) for bilateral cases and 55.5[percnt] (95[percnt] CI: 46.1-65 [percnt]) for unilateral cases. After DBS, UPDRS part III ON-stimulation/OFF-medication score in bilateral cases had a mean improvement of 53.2[percnt] (95[percnt] CI: 45.2-61.2[percnt], p<0.01) at 6 months and 53.3[percnt] (95[percnt] CI: 43.8-62.8[percnt], p<0.01) at 12 months. In unilateral cases, mean improvement in UPDRS part III ON-stimulation/OFF-medication score at 6 months was 23.7[percnt] (95[percnt] CI: 2.6- 44.9[percnt], p=0.03). Three patients had small asymptomatic subdural hemorrhages detected on post-operative imaging and 1 patient had hardware-related infection. CONCLUSIONS: iMRI-guided DBS in PD patients showed improvement in clinical outcomes as measured by their motor UPDRS scores comparable to previously reported results using awake MER-guided DBS placement. Disclosure: Dr. Sharma has nothing to disclose. Dr. Naik has nothing to disclose. Dr. Buetefisch has nothing to disclose. Dr. Triche has nothing to disclose. Dr. Willie has nothing to disclose. Dr. Boulis received a royalty payment from Neuralstem Inc. Dr. Factor has received personal compensation for activities with Lundbeck, Chelsea Therapeutics, Auspex, Neurocrin, Up-To-Date, and UCB Pharma. Dr. Factor has received personal compensation in an editorial capacity for Neurotherapeutics. Dr. Factor has r Dr. Gross has received research support from Visualase Inc. Dr. DeLong has received personal compensation for activities with Medtronic Corporation, Boston Scientific and Effron Laboratories as a consultant.

  • deep brain stimulation placement using Intraoperative MRI for dystonia one year clinical outcomes s30 003
    Neurology, 2016
    Co-Authors: Vibhash D. Sharma, Kushal B. Naik, Cathrin M. Buetefisch, Shirley Triche, Jon T. Willie, Nicholas M. Boulis, Stewart A. Factor, Robert E. Gross, Mahlon R. Delong
    Abstract:

    OBJECTIVE: To evaluate clinical outcome in patients with dystonia who underwent deep brain stimulation (DBS) placement using Intraoperative MRI (ClearPoint®, MRI interventions). BACKGROUND: DBS lead placement using Intraoperative MRI (iMRI) is an alternative surgical technique utilizing real-time Intraoperative neuroimaging to guide electrode placement. Unlike the traditional awake procedure, iMRI DBS is done under general anesthesia without microelectrode recording (MER) and electrical stimulation. However, there is limited literature on clinical outcomes. METHODS: Twenty-two consecutive dystonia patients underwent DBS surgery using iMRI. Of these, 13 patients (idiopathic, n=11; genetic, n=1, tardive n=1) were included in our analysis. Patients with secondary dystonia (n=7) and those with prior DBS placement using MER (n=2) were excluded. Pre- and post-DBS Burke-Fahn-Marsden dystonia rating scale (BFMDRS) movement scores and Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) severity scores were obtained at 6 and 12 months. RESULTS: The mean age of patients (M=6, F=7) was 55 years. Distribution of dystonia was variable with cervical dystonia as predominant component in 12 patients. All patients underwent bilateral GPi DBS placement. The mean BFMDRS and TWSTRS scores before DBS were 20 (95[percnt] CI: 12-28[percnt]) and 17.5 (95[percnt] CI: 14.7-20.2[percnt]) respectively and after DBS were 4.92 (95[percnt] CI: 3.2-6.7[percnt]) and 8.2 (95[percnt] CI: 4-12.5[percnt]) respectively at 12 months. There was a mean improvement in BFMDRS of 70.7[percnt] (95[percnt] CI: 63.8-79.5[percnt], p<0.01) and in TWSTRS of 56.4[percnt] (95[percnt] CI: 34.2 -78.6[percnt], p<0.01) at 12 months. Two patients had asymptomatic small intracranial hemorrhage, 1 had technical complications causing symptomatic intracranial hemorrhage/capsular infarct with partial hemiparesis and 1 had unilateral hardware infection/ lead fracture requiring revision. CONCLUSIONS: iMRI-guided DBS in dystonia patients showed improvement in clinical outcomes comparable to previously reported results using awake MER-guided DBS placement. This technique is particularly appropriate for children and patients where dystonia interferes with head fixation during wakefulness. Disclosure: Dr. Sharma has nothing to disclose. Dr. Naik has nothing to disclose. Dr. Triche has nothing to disclose. Dr. Buetefisch has nothing to disclose. Dr. Willie has nothing to disclose. Dr. Boulis received a royalty payment from Neuralstem Inc. Dr. Factor has received personal compensation for activities with Lundbeck, Chelsea Therapeutics, Auspex, Neurocrin, Up-To-Date, and UCB Pharma. Dr. Factor has received personal compensation in an editorial capacity for Neurotherapeutics. Dr. Factor has r Dr. Gross has received research support from Visualase Inc. Dr. DeLong has received personal compensation for activities with Medtronic Corporation, Boston Scientific and Effron Laboratories as a consultant.

Christopher Nimsky - One of the best experts on this subject based on the ideXlab platform.

  • Resective surgery for medically refractory epilepsy using Intraoperative MRI and functional neuronavigation: the Erlangen experience of 415 patients.
    Neurosurgical focus, 2016
    Co-Authors: Karl Roessler, Andrea Hofmann, Bjoern Sommer, P. Grummich, Roland Coras, Burkard Sebastian Kasper, Hajo M. Hamer, Ingmar Blümcke, Hermann Stefan, Christopher Nimsky
    Abstract:

    OBJECTIVE Intraoperative overestimation of resection volume in epilepsy surgery is a well-known problem that can lead to an unfavorable seizure outcome. Intraoperative MRI (iMRI) combined with neuronavigation may help surgeons avoid this pitfall and facilitate visualization and targeting of sometimes ill-defined heterogeneous lesions or epileptogenic zones and may increase the number of complete resections and improve seizure outcome. METHODS To investigate this hypothesis, the authors conducted a retrospective clinical study of consecutive surgical procedures performed during a 10-year period for epilepsy in which they used neuronavigation combined with iMRI and functional imaging (functional MRI for speech and motor areas; diffusion tensor imaging for pyramidal, speech, and visual tracts; and magnetoencephalography and electrocorticography for spike detection). Altogether, there were 415 patients (192 female and 223 male, mean age 37.2 years; 41% left-sided lesions and 84.9% temporal epileptogenic zones...

  • correlation of the extent of tumor volume resection and patient survival in surgery of glioblastoma multiforme with high field Intraoperative MRI guidance
    Neuro-oncology, 2011
    Co-Authors: Daniela Kuhnt, Andreas Becker, Oliver Ganslandt, Miriam H. A. Bauer, Michael Buchfelder, Christopher Nimsky
    Abstract:

    Extent of resection (EOR) still remains controversial in therapy of glioblastoma multiforme (GBM). However, an increasing number of studies favor maximum EOR as being associated with longer patient survival. One hundred thirty-five GBM patients underwent tumor resection aided by 1.5T Intraoperative MRI (iMRI) and integrated multimodal navigation. Tumor volume was quantified by manual segmentation. The influences of EOR, patient age, recurrent tumor, tumor localization, and gender on survival time were examined. Intraoperative MRI detected residual tumor volume in 88 patients. In 19 patients surgery was continued; further resection resulted in final gross total resection (GTR) for 9 patients (GTR increased from 47 [34.80%] to 56 [41.49%] patients). Tumor volumes were significantly reduced from 34.25 ± 23.68% (first iMRI) to 1.22 ± 16.24% (final iMRI). According to Kaplan-Meier estimates, median survival was 14 months (95% confidence interval [CI]: 11.7-16.2) for EOR ≥ 98% and 9 months (95% CI: 7.4-10.5) for EOR <98% (P< .0001); it was 9 months (95% CI: 7.3-10.7) for patients ≥ 65 years and 12 months (95% CI: 8.4-15.6) for patients <65 years (P < .05). Multivariate analysis showed a hazard ratio of 0.39 (95% CI: 0.24-0.63; P = .001) for EOR ≥ 98% and 0.61 (95% CI: 0.38-0.97; P < .05) for patient age <65 years. To our knowledge, this is the largest study including correlation of iMRI, tumor volumetry, and survival time. We demonstrate that navigation guidance and iMRI significantly contribute to optimal EOR with low postoperative morbidity, where EOR ≥ 98% and patient age <65 years are associated with significant survival advantages. Thus, maximum EOR should be the surgical goal in GBM surgery while preserving neurological function.

  • Correlation of the extent of tumor volume resection and patient survival in surgery of glioblastoma multiforme with high-field Intraoperative MRI guidance.
    Neuro-oncology, 2011
    Co-Authors: Daniela Kuhnt, Andreas Becker, Oliver Ganslandt, Miriam H. A. Bauer, Michael Buchfelder, Christopher Nimsky
    Abstract:

    Extent of resection (EOR) still remains controversial in therapy of glioblastoma multiforme (GBM). However, an increasing number of studies favor maximum EOR as being associated with longer patient survival. One hundred thirty-five GBM patients underwent tumor resection aided by 1.5T Intraoperative MRI (iMRI) and integrated multimodal navigation. Tumor volume was quantified by manual segmentation. The influences of EOR, patient age, recurrent tumor, tumor localization, and gender on survival time were examined. Intraoperative MRI detected residual tumor volume in 88 patients. In 19 patients surgery was continued; further resection resulted in final gross total resection (GTR) for 9 patients (GTR increased from 47 [34.80%] to 56 [41.49%] patients). Tumor volumes were significantly reduced from 34.25 ± 23.68% (first iMRI) to 1.22 ± 16.24% (final iMRI). According to Kaplan-Meier estimates, median survival was 14 months (95% confidence interval [CI]: 11.7-16.2) for EOR ≥ 98% and 9 months (95% CI: 7.4-10.5) for EOR

  • Comprar Intraoperative MRI-Guided Neurosurgery | Walter A. Hall | 9781604063059 | GEORG THIEME
    2010
    Co-Authors: Walter A. Hall, Christopher Nimsky, Charles L. Truwit
    Abstract:

    Tienda online donde Comprar Intraoperative MRI-Guided Neurosurgery al precio 139,60 € de Walter A. Hall | Christopher Nimsky | Charles L. Truwit MD, tienda de Libros de Medicina, Libros de Cirugia - Neurocirugia

Frederick A Boop - One of the best experts on this subject based on the ideXlab platform.

  • Preliminary experience with an Intraoperative MRI-compatible infant headholder: technical note
    Journal of neurosurgery. Pediatrics, 2015
    Co-Authors: Frederick A Boop, Asim F Choudhri, Berkeley G. Bate, Brian Burkholder, Paul Klimo
    Abstract:

    The development of high-quality Intraoperative MRI (iMRI) capability has offered a major advance in the care of patients with complex intracranial disease. To date, this technology has been limited by the need for pin fixation of the calvaria. The authors report their preliminary experience with an MRI-compatible horseshoe headrest that allows for the following: 1) iMRI in patients too young for pin fixation; 2) iMRI in patients with large calvarial defects; 3) the ability to move the head during iMRI surgery; and 4) the use of neuronavigation in such cases. The authors report 2 cases of infants in whom the Visius Surgical Theatre horseshoe headrest (IMRIS Inc.) was used. Image quality was equivalent to that of pin fixation. The infants suffered no skin issues. The use of neuronavigation with the system remained accurate and could be updated with the new iMRI information. The Visius horseshoe headrest offers a technical advance in iMRI technology for infants, for patients with cranial defects or prior cra...

  • 3t Intraoperative MRI for management of pediatric cns neoplasms
    American Journal of Neuroradiology, 2014
    Co-Authors: Asim F Choudhri, Paul Klimo, Tyler S Auschwitz, Matthew T Whitehead, Frederick A Boop
    Abstract:

    BACKGROUND AND PURPOSE: High-field-strength Intraoperative MR imaging has emerged as a powerful adjunct for resection of brain tumors. However, its exact role has not been firmly established. We sought to determine the impact of 3T-Intraoperative MRI on the surgical management of childhood CNS tumors. MATERIALS AND METHODS: We evaluated patient data from a single academic children's hospital during a consecutive 24-month period after installation of a 3T-Intraoperative MRI. Tumor location, histology, surgical approach, operating room time, presence and volume of residual tumor, need for tumor and non-tumor-related reoperation, and anesthesia- and MR imaging–related complications were evaluated. Comparison with pre-Intraoperative MRI controls was performed. RESULTS: One hundred ninety-four patients underwent Intraoperative MRI–guided surgery. Of these, 168 were 18 years or younger (mean, 8.9 ± 5.0 years; 108 males/60 females). There were 65 posterior fossa tumors. The most common tumors were pilocytic astrocytoma ( n = 31, 19%), low-grade glioma ( n = 31, 19%), and medulloblastoma ( n = 20, 12%). An average of 1.2 scanning sessions was performed per patient (maximum, 3). There were no MR imaging–related safety issues. Additional tumor was resected after scanning in 21% of patients. Among patients with a preoperative goal of gross total resection, 93% achieved this goal. The 30-day reoperation rate was <1% ( n = 1), and no patient required additional postoperative MR imaging during the same hospital stay. CONCLUSIONS: Intraoperative MRI is safe and increases the likelihood of gross total resection, albeit with increased operating room time, and reduces the need for early reoperation or repeat sedation for postoperative scans in children with brain tumors. FSPGR : fast-spoiled gradient recalled iMRI : Intraoperative MRI

  • Spatial distortion due to field inhomogeneity in 3.0 tesla Intraoperative MRI.
    The neuroradiology journal, 2014
    Co-Authors: Asim F Choudhri, Paul Klimo, Eric M. Chin, Frederick A Boop
    Abstract:

    We describe a 14-year-old boy with a pilocytic astrocytoma of the left caudate head. Preoperative localization MR imaging (MRI) was performed in the operating room, and spatial distortion was noted felt to be related to head positioning relative to the isocenter of the magnetic field. The distortion artifact was subtle enough to be difficult to detect, but large enough to change the location of the lesion potentially leading to a non-diagnostic stereotactic biopsy. Repeat imaging after changing the head position to allow scanning closer to the isocenter of the magnetic field showed decreased distortion, an improvement greater than that using the manufacturer's distortion correction algorithm on the initial images. Intraoperative MRI, and its requisite limitations in positioning, requires vigilance to detect possible distortion that could alter surgical outcomes if not identified and corrected prospectively.

  • 3T Intraoperative MRI for management of pediatric CNS neoplasms.
    AJNR. American journal of neuroradiology, 2014
    Co-Authors: Asim F Choudhri, Paul Klimo, Tyler S Auschwitz, Matthew T Whitehead, Frederick A Boop
    Abstract:

    BACKGROUND AND PURPOSE: High-field-strength Intraoperative MR imaging has emerged as a powerful adjunct for resection of brain tumors. However, its exact role has not been firmly established. We sought to determine the impact of 3T-Intraoperative MRI on the surgical management of childhood CNS tumors. MATERIALS AND METHODS: We evaluated patient data from a single academic children's hospital during a consecutive 24-month period after installation of a 3T-Intraoperative MRI. Tumor location, histology, surgical approach, operating room time, presence and volume of residual tumor, need for tumor and non-tumor-related reoperation, and anesthesia- and MR imaging–related complications were evaluated. Comparison with pre-Intraoperative MRI controls was performed. RESULTS: One hundred ninety-four patients underwent Intraoperative MRI–guided surgery. Of these, 168 were 18 years or younger (mean, 8.9 ± 5.0 years; 108 males/60 females). There were 65 posterior fossa tumors. The most common tumors were pilocytic astrocytoma ( n = 31, 19%), low-grade glioma ( n = 31, 19%), and medulloblastoma ( n = 20, 12%). An average of 1.2 scanning sessions was performed per patient (maximum, 3). There were no MR imaging–related safety issues. Additional tumor was resected after scanning in 21% of patients. Among patients with a preoperative goal of gross total resection, 93% achieved this goal. The 30-day reoperation rate was

Vibhash D. Sharma - One of the best experts on this subject based on the ideXlab platform.

  • Clinical outcomes of pallidal deep brain stimulation for dystonia implanted using Intraoperative MRI.
    Journal of neurosurgery, 2019
    Co-Authors: Vibhash D. Sharma, Kushal B. Naik, Cathrin M. Buetefisch, Stewart A. Factor, Yarema B. Bezchlibnyk, Faical Isbaine, Jennifer J. Cheng, John T. Gale, Svjetlana Miocinovic, Jon T. Willie
    Abstract:

    Objective Lead placement for deep brain stimulation (DBS) using Intraoperative MRI (iMRI) relies solely on real-time Intraoperative neuroimaging to guide electrode placement, without microelectrode recording (MER) or electrical stimulation. There is limited information, however, on outcomes after iMRI-guided DBS for dystonia. The authors evaluated clinical outcomes and targeting accuracy in patients with dystonia who underwent lead placement using an iMRI targeting platform. Methods Patients with dystonia undergoing iMRI-guided lead placement in the globus pallidus pars internus (GPi) were identified. Patients with a prior ablative or MER-guided procedure were excluded from clinical outcomes analysis. Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) scores and Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) scores were assessed preoperatively and at 6 and 12 months postoperatively. Other measures analyzed include lead accuracy, complications/adverse events, and stimulation parameters. Results A total of 60 leads were implanted in 30 patients. Stereotactic lead accuracy in the axial plane was 0.93 ± 0.12 mm from the intended target. Nineteen patients (idiopathic focal, n = 7; idiopathic segmental, n = 5; DYT1, n = 1; tardive, n = 2; other secondary, n = 4) were included in clinical outcomes analysis. The mean improvement in BFMDRS score was 51.9% ± 9.7% at 6 months and 63.4% ± 8.0% at 1 year. TWSTRS scores in patients with predominant cervical dystonia (n = 13) improved by 53.3% ± 10.5% at 6 months and 67.6% ± 9.0% at 1 year. Serious complications occurred in 6 patients (20%), involving 8 of 60 implanted leads (13.3%). The rate of serious complications across all patients undergoing iMRI-guided DBS at the authors' institution was further reviewed, including an additional 53 patients undergoing GPi-DBS for Parkinson disease. In this expanded cohort, serious complications occurred in 11 patients (13.3%) involving 15 leads (10.1%). Conclusions Intraoperative MRI-guided lead placement in patients with dystonia showed improvement in clinical outcomes comparable to previously reported results using awake MER-guided lead placement. The accuracy of lead placement was high, and the procedure was well tolerated in the majority of patients. However, a number of patients experienced serious adverse events that were attributable to the introduction of a novel technique into a busy neurosurgical practice, and which led to the revision of protocols, product inserts, and on-site training.

  • Clinical Outcomes Of Deep Brain Stimulation Placement Using Intraoperative MRI for Parkinson Disease (P3.359)
    Neurology, 2016
    Co-Authors: Vibhash D. Sharma, Kushal B. Naik, Cathrin M. Buetefisch, Shirley Triche, Jon T. Willie, Nicholas M. Boulis, Stewart A. Factor, Robert E. Gross, Mahlon R. Delong
    Abstract:

    OBJECTIVE: To assess motor outcome in patients with Parkinson disease (PD) who underwent deep brain stimulation (DBS) placement using Intraoperative MRI (ClearPoint®, MRI Interventions). BACKGROUND: DBS lead placement using Intraoperative MRI (iMRI) is an alternative surgical technique utilizing real-time Intraoperative neuroimaging to guide electrode placement. Unlike the traditional awake procedure, iMRI DBS is done under general anesthesia without microelectrode recording (MER) and electrical stimulation. The procedure is beneficial in patients who cannot tolerate or prefer not to undergo an awake procedure. However, there is limited literature on clinical outcomes. METHODS: Forty-one patients with PD who underwent iMRI DBS placement were identified. Of these, patients who also had placement using MER (revision = 1, additional lead = 4) and those with pre-DBS OFF-medication UPDRS part III scores

  • Deep Brain Stimulation Placement Using Intraoperative MRI for Dystonia: One Year Clinical Outcomes (S30.003)
    Neurology, 2016
    Co-Authors: Vibhash D. Sharma, Kushal B. Naik, Cathrin M. Buetefisch, Shirley Triche, Jon T. Willie, Nicholas M. Boulis, Stewart A. Factor, Robert E. Gross, Mahlon R. Delong
    Abstract:

    OBJECTIVE: To evaluate clinical outcome in patients with dystonia who underwent deep brain stimulation (DBS) placement using Intraoperative MRI (ClearPoint®, MRI interventions). BACKGROUND: DBS lead placement using Intraoperative MRI (iMRI) is an alternative surgical technique utilizing real-time Intraoperative neuroimaging to guide electrode placement. Unlike the traditional awake procedure, iMRI DBS is done under general anesthesia without microelectrode recording (MER) and electrical stimulation. However, there is limited literature on clinical outcomes. METHODS: Twenty-two consecutive dystonia patients underwent DBS surgery using iMRI. Of these, 13 patients (idiopathic, n=11; genetic, n=1, tardive n=1) were included in our analysis. Patients with secondary dystonia (n=7) and those with prior DBS placement using MER (n=2) were excluded. Pre- and post-DBS Burke-Fahn-Marsden dystonia rating scale (BFMDRS) movement scores and Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) severity scores were obtained at 6 and 12 months. RESULTS: The mean age of patients (M=6, F=7) was 55 years. Distribution of dystonia was variable with cervical dystonia as predominant component in 12 patients. All patients underwent bilateral GPi DBS placement. The mean BFMDRS and TWSTRS scores before DBS were 20 (95[percnt] CI: 12-28[percnt]) and 17.5 (95[percnt] CI: 14.7-20.2[percnt]) respectively and after DBS were 4.92 (95[percnt] CI: 3.2-6.7[percnt]) and 8.2 (95[percnt] CI: 4-12.5[percnt]) respectively at 12 months. There was a mean improvement in BFMDRS of 70.7[percnt] (95[percnt] CI: 63.8-79.5[percnt], p

  • clinical outcomes of deep brain stimulation placement using Intraoperative MRI for parkinson disease p3 359
    Neurology, 2016
    Co-Authors: Vibhash D. Sharma, Kushal B. Naik, Cathrin M. Buetefisch, Shirley Triche, Jon T. Willie, Nicholas M. Boulis, Stewart A. Factor, Robert E. Gross, Mahlon R. Delong
    Abstract:

    OBJECTIVE: To assess motor outcome in patients with Parkinson disease (PD) who underwent deep brain stimulation (DBS) placement using Intraoperative MRI (ClearPoint®, MRI Interventions). BACKGROUND: DBS lead placement using Intraoperative MRI (iMRI) is an alternative surgical technique utilizing real-time Intraoperative neuroimaging to guide electrode placement. Unlike the traditional awake procedure, iMRI DBS is done under general anesthesia without microelectrode recording (MER) and electrical stimulation. The procedure is beneficial in patients who cannot tolerate or prefer not to undergo an awake procedure. However, there is limited literature on clinical outcomes. METHODS: Forty-one patients with PD who underwent iMRI DBS placement were identified. Of these, patients who also had placement using MER (revision = 1, additional lead = 4) and those with pre-DBS OFF-medication UPDRS part III scores <=15 (n=3) were excluded. Pre- and post- DBS UPDRS Part III scores were obtained at 6 and 12 months. RESULTS: The mean age of patients (M=23, F=10) was 63.8 years. Out of 33 patients, 26 had bilateral (GPi=23, STN=3) and 7 had unilateral (GPi=6, STN=1) implants. Before DBS, the mean improvement in UPDRS Part III score ON-medication was 59.6[percnt] (95[percnt] CI: 53.5-65.8[percnt]) for bilateral cases and 55.5[percnt] (95[percnt] CI: 46.1-65 [percnt]) for unilateral cases. After DBS, UPDRS part III ON-stimulation/OFF-medication score in bilateral cases had a mean improvement of 53.2[percnt] (95[percnt] CI: 45.2-61.2[percnt], p<0.01) at 6 months and 53.3[percnt] (95[percnt] CI: 43.8-62.8[percnt], p<0.01) at 12 months. In unilateral cases, mean improvement in UPDRS part III ON-stimulation/OFF-medication score at 6 months was 23.7[percnt] (95[percnt] CI: 2.6- 44.9[percnt], p=0.03). Three patients had small asymptomatic subdural hemorrhages detected on post-operative imaging and 1 patient had hardware-related infection. CONCLUSIONS: iMRI-guided DBS in PD patients showed improvement in clinical outcomes as measured by their motor UPDRS scores comparable to previously reported results using awake MER-guided DBS placement. Disclosure: Dr. Sharma has nothing to disclose. Dr. Naik has nothing to disclose. Dr. Buetefisch has nothing to disclose. Dr. Triche has nothing to disclose. Dr. Willie has nothing to disclose. Dr. Boulis received a royalty payment from Neuralstem Inc. Dr. Factor has received personal compensation for activities with Lundbeck, Chelsea Therapeutics, Auspex, Neurocrin, Up-To-Date, and UCB Pharma. Dr. Factor has received personal compensation in an editorial capacity for Neurotherapeutics. Dr. Factor has r Dr. Gross has received research support from Visualase Inc. Dr. DeLong has received personal compensation for activities with Medtronic Corporation, Boston Scientific and Effron Laboratories as a consultant.

  • deep brain stimulation placement using Intraoperative MRI for dystonia one year clinical outcomes s30 003
    Neurology, 2016
    Co-Authors: Vibhash D. Sharma, Kushal B. Naik, Cathrin M. Buetefisch, Shirley Triche, Jon T. Willie, Nicholas M. Boulis, Stewart A. Factor, Robert E. Gross, Mahlon R. Delong
    Abstract:

    OBJECTIVE: To evaluate clinical outcome in patients with dystonia who underwent deep brain stimulation (DBS) placement using Intraoperative MRI (ClearPoint®, MRI interventions). BACKGROUND: DBS lead placement using Intraoperative MRI (iMRI) is an alternative surgical technique utilizing real-time Intraoperative neuroimaging to guide electrode placement. Unlike the traditional awake procedure, iMRI DBS is done under general anesthesia without microelectrode recording (MER) and electrical stimulation. However, there is limited literature on clinical outcomes. METHODS: Twenty-two consecutive dystonia patients underwent DBS surgery using iMRI. Of these, 13 patients (idiopathic, n=11; genetic, n=1, tardive n=1) were included in our analysis. Patients with secondary dystonia (n=7) and those with prior DBS placement using MER (n=2) were excluded. Pre- and post-DBS Burke-Fahn-Marsden dystonia rating scale (BFMDRS) movement scores and Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) severity scores were obtained at 6 and 12 months. RESULTS: The mean age of patients (M=6, F=7) was 55 years. Distribution of dystonia was variable with cervical dystonia as predominant component in 12 patients. All patients underwent bilateral GPi DBS placement. The mean BFMDRS and TWSTRS scores before DBS were 20 (95[percnt] CI: 12-28[percnt]) and 17.5 (95[percnt] CI: 14.7-20.2[percnt]) respectively and after DBS were 4.92 (95[percnt] CI: 3.2-6.7[percnt]) and 8.2 (95[percnt] CI: 4-12.5[percnt]) respectively at 12 months. There was a mean improvement in BFMDRS of 70.7[percnt] (95[percnt] CI: 63.8-79.5[percnt], p<0.01) and in TWSTRS of 56.4[percnt] (95[percnt] CI: 34.2 -78.6[percnt], p<0.01) at 12 months. Two patients had asymptomatic small intracranial hemorrhage, 1 had technical complications causing symptomatic intracranial hemorrhage/capsular infarct with partial hemiparesis and 1 had unilateral hardware infection/ lead fracture requiring revision. CONCLUSIONS: iMRI-guided DBS in dystonia patients showed improvement in clinical outcomes comparable to previously reported results using awake MER-guided DBS placement. This technique is particularly appropriate for children and patients where dystonia interferes with head fixation during wakefulness. Disclosure: Dr. Sharma has nothing to disclose. Dr. Naik has nothing to disclose. Dr. Triche has nothing to disclose. Dr. Buetefisch has nothing to disclose. Dr. Willie has nothing to disclose. Dr. Boulis received a royalty payment from Neuralstem Inc. Dr. Factor has received personal compensation for activities with Lundbeck, Chelsea Therapeutics, Auspex, Neurocrin, Up-To-Date, and UCB Pharma. Dr. Factor has received personal compensation in an editorial capacity for Neurotherapeutics. Dr. Factor has r Dr. Gross has received research support from Visualase Inc. Dr. DeLong has received personal compensation for activities with Medtronic Corporation, Boston Scientific and Effron Laboratories as a consultant.

Jon T. Willie - One of the best experts on this subject based on the ideXlab platform.

  • Clinical outcomes of pallidal deep brain stimulation for dystonia implanted using Intraoperative MRI.
    Journal of neurosurgery, 2019
    Co-Authors: Vibhash D. Sharma, Kushal B. Naik, Cathrin M. Buetefisch, Stewart A. Factor, Yarema B. Bezchlibnyk, Faical Isbaine, Jennifer J. Cheng, John T. Gale, Svjetlana Miocinovic, Jon T. Willie
    Abstract:

    Objective Lead placement for deep brain stimulation (DBS) using Intraoperative MRI (iMRI) relies solely on real-time Intraoperative neuroimaging to guide electrode placement, without microelectrode recording (MER) or electrical stimulation. There is limited information, however, on outcomes after iMRI-guided DBS for dystonia. The authors evaluated clinical outcomes and targeting accuracy in patients with dystonia who underwent lead placement using an iMRI targeting platform. Methods Patients with dystonia undergoing iMRI-guided lead placement in the globus pallidus pars internus (GPi) were identified. Patients with a prior ablative or MER-guided procedure were excluded from clinical outcomes analysis. Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) scores and Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) scores were assessed preoperatively and at 6 and 12 months postoperatively. Other measures analyzed include lead accuracy, complications/adverse events, and stimulation parameters. Results A total of 60 leads were implanted in 30 patients. Stereotactic lead accuracy in the axial plane was 0.93 ± 0.12 mm from the intended target. Nineteen patients (idiopathic focal, n = 7; idiopathic segmental, n = 5; DYT1, n = 1; tardive, n = 2; other secondary, n = 4) were included in clinical outcomes analysis. The mean improvement in BFMDRS score was 51.9% ± 9.7% at 6 months and 63.4% ± 8.0% at 1 year. TWSTRS scores in patients with predominant cervical dystonia (n = 13) improved by 53.3% ± 10.5% at 6 months and 67.6% ± 9.0% at 1 year. Serious complications occurred in 6 patients (20%), involving 8 of 60 implanted leads (13.3%). The rate of serious complications across all patients undergoing iMRI-guided DBS at the authors' institution was further reviewed, including an additional 53 patients undergoing GPi-DBS for Parkinson disease. In this expanded cohort, serious complications occurred in 11 patients (13.3%) involving 15 leads (10.1%). Conclusions Intraoperative MRI-guided lead placement in patients with dystonia showed improvement in clinical outcomes comparable to previously reported results using awake MER-guided lead placement. The accuracy of lead placement was high, and the procedure was well tolerated in the majority of patients. However, a number of patients experienced serious adverse events that were attributable to the introduction of a novel technique into a busy neurosurgical practice, and which led to the revision of protocols, product inserts, and on-site training.

  • Clinical Outcomes Of Deep Brain Stimulation Placement Using Intraoperative MRI for Parkinson Disease (P3.359)
    Neurology, 2016
    Co-Authors: Vibhash D. Sharma, Kushal B. Naik, Cathrin M. Buetefisch, Shirley Triche, Jon T. Willie, Nicholas M. Boulis, Stewart A. Factor, Robert E. Gross, Mahlon R. Delong
    Abstract:

    OBJECTIVE: To assess motor outcome in patients with Parkinson disease (PD) who underwent deep brain stimulation (DBS) placement using Intraoperative MRI (ClearPoint®, MRI Interventions). BACKGROUND: DBS lead placement using Intraoperative MRI (iMRI) is an alternative surgical technique utilizing real-time Intraoperative neuroimaging to guide electrode placement. Unlike the traditional awake procedure, iMRI DBS is done under general anesthesia without microelectrode recording (MER) and electrical stimulation. The procedure is beneficial in patients who cannot tolerate or prefer not to undergo an awake procedure. However, there is limited literature on clinical outcomes. METHODS: Forty-one patients with PD who underwent iMRI DBS placement were identified. Of these, patients who also had placement using MER (revision = 1, additional lead = 4) and those with pre-DBS OFF-medication UPDRS part III scores

  • Deep Brain Stimulation Placement Using Intraoperative MRI for Dystonia: One Year Clinical Outcomes (S30.003)
    Neurology, 2016
    Co-Authors: Vibhash D. Sharma, Kushal B. Naik, Cathrin M. Buetefisch, Shirley Triche, Jon T. Willie, Nicholas M. Boulis, Stewart A. Factor, Robert E. Gross, Mahlon R. Delong
    Abstract:

    OBJECTIVE: To evaluate clinical outcome in patients with dystonia who underwent deep brain stimulation (DBS) placement using Intraoperative MRI (ClearPoint®, MRI interventions). BACKGROUND: DBS lead placement using Intraoperative MRI (iMRI) is an alternative surgical technique utilizing real-time Intraoperative neuroimaging to guide electrode placement. Unlike the traditional awake procedure, iMRI DBS is done under general anesthesia without microelectrode recording (MER) and electrical stimulation. However, there is limited literature on clinical outcomes. METHODS: Twenty-two consecutive dystonia patients underwent DBS surgery using iMRI. Of these, 13 patients (idiopathic, n=11; genetic, n=1, tardive n=1) were included in our analysis. Patients with secondary dystonia (n=7) and those with prior DBS placement using MER (n=2) were excluded. Pre- and post-DBS Burke-Fahn-Marsden dystonia rating scale (BFMDRS) movement scores and Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) severity scores were obtained at 6 and 12 months. RESULTS: The mean age of patients (M=6, F=7) was 55 years. Distribution of dystonia was variable with cervical dystonia as predominant component in 12 patients. All patients underwent bilateral GPi DBS placement. The mean BFMDRS and TWSTRS scores before DBS were 20 (95[percnt] CI: 12-28[percnt]) and 17.5 (95[percnt] CI: 14.7-20.2[percnt]) respectively and after DBS were 4.92 (95[percnt] CI: 3.2-6.7[percnt]) and 8.2 (95[percnt] CI: 4-12.5[percnt]) respectively at 12 months. There was a mean improvement in BFMDRS of 70.7[percnt] (95[percnt] CI: 63.8-79.5[percnt], p

  • clinical outcomes of deep brain stimulation placement using Intraoperative MRI for parkinson disease p3 359
    Neurology, 2016
    Co-Authors: Vibhash D. Sharma, Kushal B. Naik, Cathrin M. Buetefisch, Shirley Triche, Jon T. Willie, Nicholas M. Boulis, Stewart A. Factor, Robert E. Gross, Mahlon R. Delong
    Abstract:

    OBJECTIVE: To assess motor outcome in patients with Parkinson disease (PD) who underwent deep brain stimulation (DBS) placement using Intraoperative MRI (ClearPoint®, MRI Interventions). BACKGROUND: DBS lead placement using Intraoperative MRI (iMRI) is an alternative surgical technique utilizing real-time Intraoperative neuroimaging to guide electrode placement. Unlike the traditional awake procedure, iMRI DBS is done under general anesthesia without microelectrode recording (MER) and electrical stimulation. The procedure is beneficial in patients who cannot tolerate or prefer not to undergo an awake procedure. However, there is limited literature on clinical outcomes. METHODS: Forty-one patients with PD who underwent iMRI DBS placement were identified. Of these, patients who also had placement using MER (revision = 1, additional lead = 4) and those with pre-DBS OFF-medication UPDRS part III scores <=15 (n=3) were excluded. Pre- and post- DBS UPDRS Part III scores were obtained at 6 and 12 months. RESULTS: The mean age of patients (M=23, F=10) was 63.8 years. Out of 33 patients, 26 had bilateral (GPi=23, STN=3) and 7 had unilateral (GPi=6, STN=1) implants. Before DBS, the mean improvement in UPDRS Part III score ON-medication was 59.6[percnt] (95[percnt] CI: 53.5-65.8[percnt]) for bilateral cases and 55.5[percnt] (95[percnt] CI: 46.1-65 [percnt]) for unilateral cases. After DBS, UPDRS part III ON-stimulation/OFF-medication score in bilateral cases had a mean improvement of 53.2[percnt] (95[percnt] CI: 45.2-61.2[percnt], p<0.01) at 6 months and 53.3[percnt] (95[percnt] CI: 43.8-62.8[percnt], p<0.01) at 12 months. In unilateral cases, mean improvement in UPDRS part III ON-stimulation/OFF-medication score at 6 months was 23.7[percnt] (95[percnt] CI: 2.6- 44.9[percnt], p=0.03). Three patients had small asymptomatic subdural hemorrhages detected on post-operative imaging and 1 patient had hardware-related infection. CONCLUSIONS: iMRI-guided DBS in PD patients showed improvement in clinical outcomes as measured by their motor UPDRS scores comparable to previously reported results using awake MER-guided DBS placement. Disclosure: Dr. Sharma has nothing to disclose. Dr. Naik has nothing to disclose. Dr. Buetefisch has nothing to disclose. Dr. Triche has nothing to disclose. Dr. Willie has nothing to disclose. Dr. Boulis received a royalty payment from Neuralstem Inc. Dr. Factor has received personal compensation for activities with Lundbeck, Chelsea Therapeutics, Auspex, Neurocrin, Up-To-Date, and UCB Pharma. Dr. Factor has received personal compensation in an editorial capacity for Neurotherapeutics. Dr. Factor has r Dr. Gross has received research support from Visualase Inc. Dr. DeLong has received personal compensation for activities with Medtronic Corporation, Boston Scientific and Effron Laboratories as a consultant.

  • deep brain stimulation placement using Intraoperative MRI for dystonia one year clinical outcomes s30 003
    Neurology, 2016
    Co-Authors: Vibhash D. Sharma, Kushal B. Naik, Cathrin M. Buetefisch, Shirley Triche, Jon T. Willie, Nicholas M. Boulis, Stewart A. Factor, Robert E. Gross, Mahlon R. Delong
    Abstract:

    OBJECTIVE: To evaluate clinical outcome in patients with dystonia who underwent deep brain stimulation (DBS) placement using Intraoperative MRI (ClearPoint®, MRI interventions). BACKGROUND: DBS lead placement using Intraoperative MRI (iMRI) is an alternative surgical technique utilizing real-time Intraoperative neuroimaging to guide electrode placement. Unlike the traditional awake procedure, iMRI DBS is done under general anesthesia without microelectrode recording (MER) and electrical stimulation. However, there is limited literature on clinical outcomes. METHODS: Twenty-two consecutive dystonia patients underwent DBS surgery using iMRI. Of these, 13 patients (idiopathic, n=11; genetic, n=1, tardive n=1) were included in our analysis. Patients with secondary dystonia (n=7) and those with prior DBS placement using MER (n=2) were excluded. Pre- and post-DBS Burke-Fahn-Marsden dystonia rating scale (BFMDRS) movement scores and Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) severity scores were obtained at 6 and 12 months. RESULTS: The mean age of patients (M=6, F=7) was 55 years. Distribution of dystonia was variable with cervical dystonia as predominant component in 12 patients. All patients underwent bilateral GPi DBS placement. The mean BFMDRS and TWSTRS scores before DBS were 20 (95[percnt] CI: 12-28[percnt]) and 17.5 (95[percnt] CI: 14.7-20.2[percnt]) respectively and after DBS were 4.92 (95[percnt] CI: 3.2-6.7[percnt]) and 8.2 (95[percnt] CI: 4-12.5[percnt]) respectively at 12 months. There was a mean improvement in BFMDRS of 70.7[percnt] (95[percnt] CI: 63.8-79.5[percnt], p<0.01) and in TWSTRS of 56.4[percnt] (95[percnt] CI: 34.2 -78.6[percnt], p<0.01) at 12 months. Two patients had asymptomatic small intracranial hemorrhage, 1 had technical complications causing symptomatic intracranial hemorrhage/capsular infarct with partial hemiparesis and 1 had unilateral hardware infection/ lead fracture requiring revision. CONCLUSIONS: iMRI-guided DBS in dystonia patients showed improvement in clinical outcomes comparable to previously reported results using awake MER-guided DBS placement. This technique is particularly appropriate for children and patients where dystonia interferes with head fixation during wakefulness. Disclosure: Dr. Sharma has nothing to disclose. Dr. Naik has nothing to disclose. Dr. Triche has nothing to disclose. Dr. Buetefisch has nothing to disclose. Dr. Willie has nothing to disclose. Dr. Boulis received a royalty payment from Neuralstem Inc. Dr. Factor has received personal compensation for activities with Lundbeck, Chelsea Therapeutics, Auspex, Neurocrin, Up-To-Date, and UCB Pharma. Dr. Factor has received personal compensation in an editorial capacity for Neurotherapeutics. Dr. Factor has r Dr. Gross has received research support from Visualase Inc. Dr. DeLong has received personal compensation for activities with Medtronic Corporation, Boston Scientific and Effron Laboratories as a consultant.