PMC8769402_01
Surgical plan of DBS surgery based on the susceptibility-weighted fast field echo images reconstructed in parallel (left) or perpendicular (middle and right) to the electrode trajectory. No visible vessels were observed around the electrode trajectory. DBS: deep brain stimulation.
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F1
T1-weighted magnetic image and a transverse magnetic susceptibility-weighted fast field-echo image sequences (vein BOLD; veins are clearly visible in these images) using the dedicated software StealthStation (Medtronic, Minnesota, MN, USA). The tentative target was set on the dorsolateral portion of subthalamic nucleus (STN) based on the coordinate of the anterior commissure- posterior commissure (AC-PC) line and the hypo intensity region observed on susceptibility-weighted fast field-echo images, and the entry point was determined so that the trajectory did not pass through vessels in the brain, the sulcus, or the lateral ventricle, and penetrates the STN as long as possible (Fig. 1).
CT scan revealed an irregular subcortical hemorrhage associated with pronounced cerebral edema. CT: computed tomography.
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F2
CT revealed a 10 x 6.5-cm irregular subcortical hemorrhage, pronounced cerebral edema, and a 2-cm left-to-right midline shift (Fig. 2).
Intraoperative photograph (A), the early (B) and late (C) phase of the intraoperative ICG angiography. A craniotomy revealed the incised dura matter just beneath the DBS burr hole (broken line circle), but there were no coagulated bridging veins adjacent to the burr hole. ICG video angiography showed a delay in cerebral venous circulation as well as late-phase retrograde venous drainage via a superficial cerebral (large arrow head) in late phase. It took more than 20 seconds from the delineation of the subpial veins (small arrow heads in B) to subarachnoid veins (large arrow head in C). ICG angiography also revealed another venous lacuna just posterior to the incised dura mater at the DBS surgery (broad arrow in B and C), and a small cortical vein (fine arrow in B and C) emptied directly into this lacuna. DBS: deep brain stimulation, ICG: indocyanine green.
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F3
Intraoperative indocyanine green (ICG) video angiography showed a delay in cerebral venous circulation as well as late-phase retrograde venous drainage via a superficial cerebral vein (Fig. 3). ICG angiography also revealed another venous lacuna just posterior to the DBS burr hole, and a small cortical vein emptied directly into this lacuna (Fig. 3).