Deep brain stimulation electrode anchoring using BioGlue®, a protective electrode covering, and a titanium microplate

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Abstract

The authors present an easily applicable deep brain stimulation (DBS) electrode anchoring technique for use in human and experimental animals. The anchoring technique combines the use of fibrin glue, a two-component surgical adhesive (BioGlue®), a protective electrode covering, and a titanium microplate. The BioGlue® (CryoLife International, Inc., Kennesaw, GA, USA) hinders unwanted electrode movement during the electrode fixation step and seals the burr hole, while the protective electrode covering protects the electrode under the titanium microplate which keeps the electrode in a permanent position. The described technique further has the advantage of being cosmetically acceptable to the human patient, and furthermore it perfectly adapts to the smaller and irregular-shaped skull in experimental animals.

The described technique has clinically been used to implant DBS-electrodes in the subthalamic nucleus for Parkinson disease and is the preferred DBS-electrode anchoring technique for our experimental DBS-studies in the Göttingen minipig.

Introduction

Chronic deep brain stimulation (DBS) has proved an effective treatment for Parkinson disease, essential tremor, and dystonia, and is currently under investigation in epilepsy, pain and neuropsychiatric diseases (Bjarkam and Sørensen, 2004, Gross, 2004). The use of DBS can lead to hardware complications such as electrode migration and electrode fracture (Hamani and Lozano, 2006, Lyons et al., 2004, Oh et al., 2002), which may be caused by a suboptimal electrode implantation and fixation technique. It has thus been noted that the use of burr hole caps, e.g. the Medtronic cap or the Navigus/stimlock system for electrode anchoring may cause post-stereotaxic electrode movement (Lee et al., 2005, Wharen et al., 2005). The protrusion of the cap under the galea is, furthermore, cosmetically unacceptable to many patients (Yamamoto et al., 2003), while the size of the cap in itself often exclude use of such procedures in experimental animals due to their smaller and irregular-shaped skulls (personal experience). Electrode fixation with a titanium microplate (Favre et al., 1996) alone may on the other hand damage the electrode (Oh et al., 2002) and CSF may leak from the unclosed burr hole (Lee et al., 2005).

We present, accordingly, a newly developed cosmetically acceptable anchoring technique for use in humans and experimental animals, which closes the burr hole and keeps the electrode in place during the post-stereotaxic intra-operative handling and permanently postoperatively without damage to the fixated electrode.

Section snippets

Human surgical procedure

Coordinates for the subthalamic nucleus (STN) was determined by the Surgiplan software based on preoperative T2-weighted MRI of Leksell-frame fitted patients. Medtronic DBS model 3389 electrodes were stereotaxically inserted bilaterally into the STN through two 14 mm precoronal burr holes burred by a Midas Rex high-speed pneumatic cranial drill system. The intracerebral electrode placement was guided by microelectrode recordings and intraoperative clinical evaluation for the determination of the

Experimental animal surgical procedure

Six female Göttingen minipigs, age 8–12 months, weight 20–30 kg, were used for implantation of 0.7 mm wide DBS-electrodes (Deep Brain Stimulation Lead 44–0149–01, ANS, Plano Texas, USA) in either the pontine micturition center (two animals) or the prefrontal cortex (four animals) in accordance with a protocol approved by the Danish Council for Animal Research Ethics. The animals were sedated with 5 ml midazolam (5 mg/ml) and 5 ml ketamine (2.5 mg/ml) i.m. before ear-vein catheterization and injection

Experimental animal perfusion and postmortem handling

The animals were given an overdose of pentobarbital and perfused transcardially with 5 l phosphate buffered 4% paraformaldehyde (pH 7.4). The skull was opened, the brain removed and immersed in the fixative for 24 h. It was then embedded and oriented in HistOmer (HistOtech ApS, Denmark) followed by sectioning into 15 mm thick coronal tissue slabs (Bjarkam et al., 2001, Sørensen et al., 2000). The coronal brain slab corresponding to the target area was placed in a 30% sucrose solution for 24 h,

Results

The described technique has successfully been used to anchor implanted DBS-electrodes in the subthalamic nucleus for Parkinson disease in human patients and in chronic DBS-studies performed in experimental animals as verified by postoperative MRI. Surgical or hardware complications were neither encountered in the humans or the experimental animals. The two patients had a satisfactory clinical and cosmetical outcome, and continue today 14 and 22 months postoperatively, respectively to have a

Discussion

Permanent and reliable DBS-electrode anchoring is a prerequisite for a successful treatment and experimental study response (Bjarkam et al., 2005, Lyons et al., 2004, Oh et al., 2002). Several reports indicate, however, that electrode migration and electrode fracture are common (Alterman et al., 2001, Bjarkam et al., 2005, Hamani and Lozano, 2006, Lee et al., 2005, Lyons et al., 2004, Wharen et al., 2005). Electrode anchoring are currently performed by several techniques and devices such as

Acknowledgements

This study was financially supported by The Danish Parkinson Association, The Aase and Ejnar Danielsen Foundation and The Karen Elise Jensen Foundation. We acknowledge with gratitude the technical assistance of Mrs. Dorete Jensen and Lise Moberg Fitting.

References (19)

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