Background: Intracerebral hemorrhage (ICH) is the most feared complication in deep brain stimulation (DBS) surgery. The aim of the study was to evaluate patient safety and outcome using laser Doppler flowmetry (LDF) as guidance tool during DBS implantations. Methods: An LDF probe adapted for the stereotactic system was used as guide for creation of the trajectory. The microcirculation along 83 preplanned trajectories was measured with the guide during DBS surgery for movement disorders. The microvascular blood flow levels were investigated for all measurement positions. Medical record and postoperative radiology were retrospectively reviewed. Results: Of 2,963 measurement positions, 234 (7.9%) showed at least a doubled blood flow compared to the surrounding tissue. Of these 2.2% had a more than 5 times higher blood flow in front of the probe tip. Along 1 trajectory, a small ICH was detected during surgery. Increased blood flow was more common close to sulci and verticals. Conclusion: Real-time LDF measurement of the microcirculation using a forward-looking probe during DBS surgery can detect blood flow peaks and further minimize the risk of developing ICH. No separate guide tube is necessary as the probe also creates the trajectory for the DBS lead.

Keywords:
Deep brain stimulation, Laser Doppler flowmetry, Intracerebral hemorrhage, Safety
1.
Xiaowu H, Xiufeng J, Xiaoping Z, Bin H, Laixing W, Yiqun C, Jinchuan L, Aiguo J, Jianmin L: Risks of intracranial hemorrhage in patients with Parkinson's disease receiving deep brain stimulation and ablation. Parkinsonism Relat Disord 2010;16:96-100.
2.
Elias WJ, Sansur CA, Frysinger RC: Sulcal and ventricular trajectories in stereotactic surgery. J Neurosurg 2009;110:201-207.
3.
Zrinzo L, Foltynie T, Limousin P, Hariz MI: Reducing hemorrhagic complications in functional neurosurgery: a large case series and systematic literature review. J Neurosurg 2012;116:84-94.
4.
Fenoy AJ, Simpson RK Jr: Risks of common complications in deep brain stimulation surgery: management and avoidance. J Neurosurg 2014;120:132-139.
5.
Gorgulho A, De Salles AA, Frighetto L, Behnke E: Incidence of hemorrhage associated with electrophysiological studies performed using macroelectrodes and microelectrodes in functional neurosurgery. J Neurosurg 2005;102:888-896.
6.
Zibetti M, Romagnolo A, Crobeddu E, Fornaro R, Merola A, Rizzone MG, Lopiano L, Lanotte M: Does intraoperative microrecording really increase the risk of hemorrhagic complications in deep brain stimulation? Brain Stimul 2014;7:911-912.
7.
Telkes I, Ince NF, Onaran I, Abosch A: Localization of subthalamic nucleus borders using macroelectrode local field potential recordings. Conf Proc IEEE Eng Med Biol Soc 2014;2014:2621-2624.
8.
Zrinzo L, Hariz M: Impedance recording in functional neurosurgery; in Lozano AM, Gildenberg PL, Tasker R (eds): Textbook of Stereotactic and Functional Neurosurgery. Berlin, Springer, 2009, pp 1325-1330.
9.
Terao T, Takahashi H, Yokochi F, Taniguchi M, Okiyama R, Hamada I: Hemorrhagic complication of stereotactic surgery in patients with movement disorders. J Neurosurg 2003;98:1241-1246.
10.
Strömberg T, Wårdell K, Larsson M, Salerud S: Laser Doppler monitoring and imaging techniques; in Vo-Dinh T (ed): Biomedical Photonics Handbook. Boca Raton, CRC, 2014, pp 435-459.
11.
Wårdell K, Blomstedt P, Richter J, Antonsson J, Eriksson O, Zsigmond P, Bergenheim AT, Hariz MI: Intracerebral microvascular measurements during deep brain stimulation implantation using laser Doppler perfusion monitoring. Stereotact Funct Neurosurg 2007;85:279-286.
12.
Wårdell K, Zsigmond P, Richter J, Hemm S: Relationship between laser Doppler signals and anatomy during deep brain stimulation electrode implantation toward the ventral intermediate nucleus and subthalamic nucleus. Neurosurgery 2013;72(2 suppl Operative): ONS127-140.
13.
Giller CA, Liu HL, Gurnani P, Victor S, Yasdani U, German DC: Validation of a near-infrared probe for detection of thin intracranial white matter structures. J Neurosurg 2003;98:1299-1306.
14.
Antonsson J, Eriksson O, Blomstedt P, Bergenheim AT, Hariz MI, Richter J, Zsigmond P, Wårdell K: Diffuse reflectance spectroscopy measurements for tissue-type discrimination during deep brain stimulation. J Neural Eng 2008;5:185-190.
15.
Giller CA, Liu H, German DC, Kashyap D, Dewey RB: A stereotactic near-infrared probe for localization during functional neurosurgical procedures: further experience. J Neurosurg 2009;110:263-273.
16.
Johansson JD, Blomstedt P, Haj-Hosseini N, Bergenheim AT, Eriksson O, Wårdell K: Combined diffuse light reflectance and electrical impedance measurements as a navigation aid in deep brain surgery. Stereotact Funct Neurosurg 2009;87:105-113.
17.
Wårdell K: Optical monitoring techniques for navigation during stereotactic neurosurgery. Sensors Mater 2016;28:1105-1116.
18.
Blomstedt P, Sandvik U, Linder J, Fredricks A, Forsgren L, Hariz MI: Deep brain stimulation of the subthalamic nucleus versus the zona incerta in the treatment of essential tremor. Acta Neurochir (Wien) 2011;153:2329-2335.
19.
Jacobs P: Sterrad 100S, sterilisation system. Johnson & Johnson, 2006.
20.
Wårdell K, Hemm-Ode S, Rejmstad P, Zsigmond P: High-resolution laser Doppler measurements of microcirculation in the deep brain structures: a method for potential vessel tracking. Stereotact Funct Neurosurg 2016;94:1-9.
21.
Tonge M, Ackermans L, Kocabicak E, van Kranen-Mastenbroek V, Kuijf M, Oosterloo M, Kubben P, Temel Y: A detailed analysis of intracerebral hemorrhages in DBS surgeries. Clin Neurol Neurosurg 2015;139:183-187.
22.
Zrinzo L, van Hulzen AL, Gorgulho AA, Limousin P, Staal MJ, De Salles AA, Hariz MI: Avoiding the ventricle: a simple step to improve accuracy of anatomical targeting during deep brain stimulation. J Neurosurg 2009;110:1283-1290.
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2018
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