PMC5402338_01
MRI and CT images of patient with cochlear implant after magnet removal demonstrating various degrees of signal artifact. (a) T1W axial section demonstrates artifact extending to the subcortical white matter of posterior temporal lobe. (b and c) T2W and SWI sequences, respectively, showing undistorted anatomy of subthalamic nucleus and midbrain structures. Arrows show medial STN borders. (d) Axial noncontrast CT with normal visualization of fiducial markers on the localizer
SNI-8-47-g001.jpg
PMC5402338_01_SNI-8-47-g001.jpg
F1
T2 axial, and SWI axial sequences) [Figure 1]. The following day, on the morning of surgery, after appropriate local anesthetic and betadine was applied to the patient's head, a Leksell Model G Stereotactic Frame (Elekta, Stockholm, Sweden) was applied in the standard fashion. A high-resolution 1 mm slice non-contrast CT study was then obtained [Figure 1] after frame placement and computationally merged with the preoperative MRI in the workstation. Of note, both STN and globus pallidus pars interna (GPi) were successfully visualized on T2 and SWI sequences [Figure 1].
Intraoperative photograph demonstrating the use of a computer monitor to communicate with the patient that has sensorineural hearing loss during DBS surgery
SNI-8-47-g003.jpg
PMC5402338_01_SNI-8-47-g003.jpg
F2
Given the patient's severe sensorineural hearing loss, communication with the patient was achieved using computer-generated text displayed on an operating room monitor [Figure 2].
Merged iCT images with preoperative MRI. (a-c) Left SWI sequences in the axial, sagittal, and coronal planes showing final DBS distal contact location in relation to the original target (yellow). (d-f) Right SWI sequences demonstrating final DBS location compared to the target (green)
SNI-8-47-g004.jpg
PMC5402338_01_SNI-8-47-g004.jpg
F3
The leads (model 3389, Medtronic, Inc., Minneapolis, Minnesota) were subsequently assembled and advanced to target. iCT images were obtained and computationally merged with the preoperative CT [Figure 3].