Optimization of postoperative computerized tomographic imaging in patients with the implanted responsive neurostimulation system.
ABSTRACT The Responsive Neurostimulation System is currently under investigation as a neurosurgical option for medically refractory epilepsy. The device produces significant metallic artifact on conventional axial CT scans, resulting in limited diagnostic imaging options for implanted patients. We have developed a strategy to overcome this technical difficulty utilizing optimized patient positioning, thin-slice image acquisition, and postprocessing image reconstruction with commercially available software. Significant improvements were noted in the severity of device-related metallic streak artifact on reconstructed axial images. In addition, thin-section data were successfully used to generate detailed three-dimensional reconstructions, providing for improved visualization of the stimulator and the intracranial position of attached electrodes.
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ABSTRACT: X-ray microtomography (micro-CT) is a new technique allowing for visualization of the internal structure of opaque specimens with a quasi-histological quality. Among multiple potential applications, the use of this technique in otology is very promising. Micro-CT appears to be ideally suited for in vitro visualization of the inner ear tissues as well as for evaluation of the electrode damage and/or surgical insertion trauma during implantation of the cochlear implant electrodes. This technique can greatly aid in design and development of new cochlear implant electrodes and is applicable for temporal bone studies. The main advantage of micro-CT is the practically artefact-free preparation of the samples and the possibility of evaluation of the interesting parameters along the whole insertion depth of the electrode. This paper presents the results of the first application of micro-CT for visualization of the inner ear structures in human temporal bones and for evaluation of the surgical positioning of the cochlear implant electrodes relative to the intracochlear soft tissues.Acta Oto-laryngologica - ACTA OTO-LARYNGOL. 01/2006; 126(5):467-474.
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ABSTRACT: The electrode Activa 3389 is widely implanted for deep brain stimulation (DBS) and MRI is often used to control the position of the electrode. However, induced distorsion artifacts may result in imprecise localization and may lead to misinterpretations of the clinical effects and mechanisms of DBS. In vitro 3D MR study: the proximal and distal contacts of one electrode were spotted by two localizers. The maximal artifact height (MAH) and width (MAW: measured on distal contact), and the distances between the artifact and the localizers (proximal, distal and lateral) were measured on 2 transverse and sagittal MR sequences with 90 degrees rotation of frequency-encoded gradient and phase direction. In vivo 3D MR study: coronal and sagittal reconstructions along the main axis of the electrode were performed on 10 postoperative MR (20 electrodes) to measure MAH and MAW. A Student t test was used to compare in vitro and in vivo measurements. In vitro study: A MAH of 10.35 mm (+/-0.23) and MAW of 3.6 mm (+/-0.2) were found. We measured symmetrical extensions of the artifact over the distal contact. In vivo study: A MAH of 10.36 mm (+/-0.44) and MAW of 3.56 mm (+/-0.30) were obtained. No significant different artifact dimensions were measured between in vitro and in vivo studies (p<0.0001). Precise 3D localization of the electrode in implanted patients is provided by MR identification of the limits of the distal contact artifact. The position of the other contacts is deduced given the size of the contacts and the intercontact distance.Acta Neurochirurgica 03/2004; 146(2):161-4. · 1.79 Impact Factor
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ABSTRACT: We report on the development of an electroencephalographic (EEG) recording system that is Magnetic Resonance Imaging (MRI) compatible and can safely be left on the scalp during anatomical imaging or used to obtain simultaneous EEG and metabolic or hemodynamic data using functional imaging techniques such as functional MRI or MR spectroscopy. We assembled a versatile EEG recording set-up with medically acceptable materials that contained no ferromagnetic components. It was tested for absence of excess heating and distortion of the image quality in a spherical phantom similar in size to average adult human head in a clinical 1.5 T GE scanner. After testing its safety in four volunteers, 100 consecutive patients from our epilepsy long-term monitoring unit were studied. There was no change in the temperature of the EEG electrode discs during the various anatomical MRI sequences used in our routine clinical studies (maximum temperature change was -0.45 degrees C with average head SAR<==1.6 W/Kg in the selected subjects) nor were there any reported complications in the others. The brain images were not distorted by the susceptibility artifact of the EEG electrodes. Our MRI compatible EEG set-up allows safe and artifact free brain imaging in 1.5T MR scanner with average SAR<==1.6 W/Kg. This EEG system can be used for EEG recording during anatomical MRI studies as well as functional imaging studies in patients requiring continuous EEG recordings.Clinical Neurophysiology 10/2004; 115(9):2175-80. · 2.98 Impact Factor