MRI-guided and MRI-verified deep brain stimulation (DBS)

Deep brain stimulation is the main type of surgery that has been performed for decades, to treat the physical symptoms of Parkinson’s, and some other movement disorders/dystonia. It involves implanting very fine wires, with electrodes at their tips, into the brain. These are connected to extensions that are tunnelled under the skin behind the ear and down the neck, which are then connected to a pulse generator (a device like a pacemaker), which is placed under the skin around the chest or stomach area. When the device is switched on, the electrodes deliver high frequency stimulation to the targeted area. This stimulation changes some of the electrical signals in the brain that cause the symptoms of Parkinson’s.

As DBS aims to improve quality of life, safety is an absolute priority. Large patient series studies have shown that an MRI-guided and MRI-verified approach carries a lower risk of haemorrhage and deficit than other surgical methods, with favourable long-term clinical outcomes.

MRI sequences can accurately localize intracranial structures directly in individual patients under general anaesthesia (GA), without the need for conscious intraoperative clinical testing or neurophysiological recording. The radiological anatomy enables direct targeting, confirms lead position, and guides relocation if required.

Additional benefits of the MRI-guided and MRI-verified approach include increased patient comfort and reduced anxiety as well as avoidance of complete medication withdrawal, and consequently less confusion experienced by the patient in the perioperative period.

Milpark Radiology Inc. in conjunction with the neurology and neurosurgical teams led by Dr D Anderson, Specialist Neurologist, and Dr M Zorio, Specialist Neurosurgeon, have the equipment and expertise to utilise the MRI guided and verified surgical technique at our institution.

Our multidisciplinary team has been fortunate to be advised and mentored by Dr L Zrinzo and the highly experienced team at University College London, and are invaluably supported by the dedicated team from Medtronic.

By observing very strict parameters and precautions, the majority of patients with implanted DBS hardware can be safely imaged with MRI.

In the past year since inception, more than 20 MRI guided and verified DBS procedures have been performed at Milpark Hospital, and numerous patients with pre-existing DBS implants have safely undergone MRI imaging for other indications in our Radiology department.

Dr Rebecca Such



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