Olivia HustonOlivia HustonKendall Lee MD, PhDKendall Lee MD, PhD

Robert Watson MD, PhDRobert Watson MD, PhDMatt Bernstein PhDMatt Bernstein PhD

John Huston MDJohn Huston MDKiaran McGee PhDKiaran McGee PhD

Intraoperative MRI Imaging Intraoperative MRI Imaging Strategies to Evaluate for Strategies to Evaluate for Complications during DBS Complications during DBS

SurgerySurgery

Mayo Clinic Rochester, MNMayo Clinic Rochester, MN

Intraoperative MRI During Intraoperative MRI During

DBS SurgeryDBS Surgery PurposePurpose

To determine the optimal imaging To determine the optimal imaging sequences, the imaging findings and sequences, the imaging findings and the clinical consequences of those the clinical consequences of those findings for MRI performed during findings for MRI performed during DBS surgery. DBS surgery.

Intraoperative MRI During Intraoperative MRI During DBS SurgeryDBS Surgery

MethodsMethods• 143 patients underwent 152 DBS 143 patients underwent 152 DBS

surgeries utilizing intraoperative 1.5T surgeries utilizing intraoperative 1.5T MRI. MRI.

• MRI sequences utilized:MRI sequences utilized:- T1 MP-RAGE - T1 MP-RAGE pre and intra-oppre and intra-op- T2* GRE - T2* GRE intra-opintra-op- T2 FLAIR - T2 FLAIR selectivelyselectively- T2 FSE - T2 FSE selectivelyselectively

Intraoperative MRI During Intraoperative MRI During DBS SurgeryDBS Surgery

ResultsResults

Number of Surgeries: 152Number of Surgeries: 152

• Subdural Hematomas: 5Subdural Hematomas: 5• Subarachnoid Hemorrhages: 3Subarachnoid Hemorrhages: 3• Intraparenchymal Intraparenchymal

Hemorrhage: 1Hemorrhage: 1• Subarachnoid Air: 4Subarachnoid Air: 4• Brain Shift: 144Brain Shift: 144

Intraoperative MRI During Intraoperative MRI During DBS SurgeryDBS Surgery

Subdural HematomaSubdural Hematoma

• Number of SDH: 5Number of SDH: 5

• Average thickness: 5.2 mmAverage thickness: 5.2 mm

• Range: 4-8 mmRange: 4-8 mm

Subdural Hematoma

Intraoperative MRI During Intraoperative MRI During DBS SurgeryDBS Surgery

Subarachnoid HemorrhageSubarachnoid Hemorrhage

• Number of SAH: 3Number of SAH: 3

• One patient experienced headache and One patient experienced headache and disorientation requiring 2 additional disorientation requiring 2 additional days of hospitalization. Symptoms days of hospitalization. Symptoms cleared prior to discharge.cleared prior to discharge.

Subarachnoid Hemorrhage

Intraoperative MRI During Intraoperative MRI During DBS SurgeryDBS Surgery

Intraparenchymal HemorrhageIntraparenchymal Hemorrhage

• Number Hemorrhages: 1Number Hemorrhages: 1

• 5 x 5 mm 5 x 5 mm

Intraparenchymal Hemorrhage

Intraoperative MRI During Intraoperative MRI During DBS SurgeryDBS Surgery

Subarachnoid AirSubarachnoid Air

• Number of SA Air: 4Number of SA Air: 4

Subarachnoid Air

Intraoperative MRI During Intraoperative MRI During DBS SurgeryDBS SurgeryBrain ShiftBrain Shift

• Number with Shift: 144Number with Shift: 144

• Average: 0.6 cmAverage: 0.6 cm

• Range: 0.1-1.3 cmRange: 0.1-1.3 cm

Brain Shift

Intraoperative MRI During Intraoperative MRI During DBS SurgeryDBS Surgery ConclusionsConclusions

• Intracranial hemorrhage is occasionally Intracranial hemorrhage is occasionally identified but is rarely clinically significant. identified but is rarely clinically significant. One delayed SDH required evacuation.One delayed SDH required evacuation.

• Brain shift during DBS surgery is common.Brain shift during DBS surgery is common.

• Subarachnoid air mimics subarachnoid Subarachnoid air mimics subarachnoid blood on GRE.blood on GRE.

• Selective use of T2 FLAIR and T2 FSE Selective use of T2 FLAIR and T2 FSE imaging can confirm the presence imaging can confirm the presence hemorrhage or air and precludes the need hemorrhage or air and precludes the need for CT exams.for CT exams.