Lead Cap Localization using Ultrasound in Deep Brain Stimulation Surgery: Technical Note

Abstract

In deep brain stimulation (DBS) surgery, after intracranial lead implantation, lead caps are tunneled into the subgaleal space for later connection to internal pulse generator (IPG) extension wires. In the subsequent IPG implantation procedure, the lead cap must be localized by palpation in order to plan an incision in the scalp to complete this connection. However, if the IPG implantation is done the same day as the intracranial lead implantation, palpation of the lead cap may be challenging in a thick or postoperatively edematous scalp. Manufacturers suggest using fluoroscopy in these instances, but fluoroscopy provides poor soft tissue visualization, requires further unnecessary radiation exposure to both the patient and the surgical team, and can be cumbersome. Portable ultrasound (US) machines are readily available in many operating rooms, and can be used to easily and accurately localize the lead cap prior to IPG implantation.

Key words

deep brain stimulation - fluoroscopy - ultrasound

References

• 1 Pena E, Pastor J, Hernando V. et al . Skin erosion over implants in deep brain stimulation patients.  Stereotact Funct Neurosurg. 2008;  86 120-126
• 2 Sherif C, Dorfer C, Kalteis K. et al . Deep brain pulse-generator and lead-extensions: subjective sensations related to measured parameters.  Movement Disord. 2008;  23 1036-1040
• 3 Lead Kit for Deep Brain Stimulation Implant Manual.. Minneapolis, MN: Medtronic, Inc; 2008

Correspondence