case_images: PMC11011943_01
case_images: A, BenGun configuration. B, a representation of the DBS lead being placed in one of the off-center channels of the BenGun while the MER canula is held in place. DBS, deep brain stimulation; GPi, globus pallidus interna; GPe, globus pallidus externa.
case_images: tohm-14-1-873-g1.jpg
case_images: PMC11011943_01_tohm-14-1-873-g1.jpg
case_images: F1
case_images: Figure 1). Following the DBS lead placement, we performed an intra-operative monopolar review, and we confirmed the clinical benefit was associated with adequate thresholds for stimulation-induced side effects (Table 1). The BenGun style array which was employed for MER in this case is shown in Figure 1.
case_images: A, B, C: Different cuts of CT scan done immediately after lead implantation. There is significant left frontal pneumocephalus leading to brain shift in the posterior and medial direction. D: Resolved pneumocephalus at a four-weeks interval.
case_images: tohm-14-1-873-g2.jpg
case_images: PMC11011943_01_tohm-14-1-873-g2.jpg
case_images: F2
case_images: An intra-operative CT was then performed and a large volume of pneumocephalus was visualized and there was clear brain shift in the posterior and medial direction (Figure 2). The follow up CT collected at the same visit revealed resolution of the pneumocephalus (Figure 2). Once the pneumocephalus resolved at four-weeks post-operatively, the brain shift subsided (Figure 2) and we used the new currently obtained CT to localize the lead.
case_images: Lead reconstruction of the left GPi DBS lead. The red lead represents the reconstruction performed using the intraoperative CT, when the pneumocephalus and brain shift were present. The green lead represents the reconstruction performed using the post-operative CT (around 1 month later) following resolution of the pneumocephalus and brain shift. A, provides an axial section of a brain MRI collected using the FGATIR sequence. B and C, provide 3D reconstructions of the DBS lead in the left GPi (figure for orientation in the lower left).
case_images: tohm-14-1-873-g3.jpg
case_images: PMC11011943_01_tohm-14-1-873-g3.jpg
case_images: F3
case_images: Post-operative lead reconstructions showed the final lead was in the posteroventral GPi region (Figure 3). In our case, immediate post-operative lead reconstruction suggested that the lead was medial and posterior (Figure 3, red lead). The DBS lead was ultimately placed antero-lateral to the initial trajectory (Figure 3, green lead).