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J Neurol Surg A Cent Eur Neurosurg 2024; 85(03): 288-293
DOI: 10.1055/s-0043-1775759
Review Article

Evaluation of the Rotational Stability of Directional Deep Brain Stimulation Leads: A Case Series and Systematic Review

Fabian Cavalloni 
1   Department of Neurosurgery, Kantonsspital Sankt Gallen, Sankt Gallen, Switzerland
2   Department of Neurosurgery, Inselspital, University Hospital of Berne, Berne, Switzerland
,
Florian Brugger
3   Department of Neurology, Kantonsspital Sankt Gallen, Sankt Gallen, Switzerland
,
Georg Kägi
3   Department of Neurology, Kantonsspital Sankt Gallen, Sankt Gallen, Switzerland
,
Yashar Naseri
1   Department of Neurosurgery, Kantonsspital Sankt Gallen, Sankt Gallen, Switzerland
5   Department of Neurosurgery, Freiburg University Medical Center, Freiburg, Germany
,
Deborah Brogle
3   Department of Neurology, Kantonsspital Sankt Gallen, Sankt Gallen, Switzerland
,
Oliver Bozinov
1   Department of Neurosurgery, Kantonsspital Sankt Gallen, Sankt Gallen, Switzerland
,
Ronald Bauer
4   Department of Neurosurgery, Kantonsspital Aarau AG, Aarau, Switzerland
,
Stefan Hägele-Link
3   Department of Neurology, Kantonsspital Sankt Gallen, Sankt Gallen, Switzerland
,
Marie Therese Krüger
1   Department of Neurosurgery, Kantonsspital Sankt Gallen, Sankt Gallen, Switzerland
5   Department of Neurosurgery, Freiburg University Medical Center, Freiburg, Germany
› Author Affiliations Funding None.
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Abstract

Background The rotational stability of directional deep brain stimulation leads is a major prerequisite for sustained clinical effects. Data on directional lead stability are limited and controversial.

Methods We aimed to evaluate the long-term rotational stability of directional leads and define confounding factors in our own population and the current literature. We retrospectively evaluated the orientation of directional leads in patients with available postoperative computed tomography (CT; T1; day of surgery) and an additional postoperative image (T2; CT or rotational fluoroscopy) performed more than 7 days after the initial scan. The potential impact of intracranial air was assessed. We also reviewed the literature to define factors impacting stability.

Results Thirty-six leads were evaluated. The mean follow-up between T1 and T2 was 413.3 (7–1,171) days. The difference in rotation between T1 and T2 was 2.444 ± 2.554 degrees (range: 0–9.0 degrees). The volume of intracranial air did not impact the rotation. The literature search identified one factor impacting the stability of directional leads, which is the amount of twist applied at implantation.

Conclusion Directional leads for deep brain stimulation show stable long-term orientation after implantation. Based on our literature review, large amounts of twist during implantation can lead to delayed rotation and should thus be avoided.

Keywords

deep brain stimulation - directional deep brain stimulation - lead orientation - directional lead - lead rotation

Clinical Trial Registration

Full name and URL of the registry is EU Clinical Trials Register (https://www.clinicaltrialsregister.eu).


Registration number of your study is included in the manuscript (swissethics BASEC).


The type of study was retrospective monocenter study.


Supplementary Material



Publication History

Received: 26 June 2022

Accepted: 28 October 2022

Article published online:
13 October 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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