Department first in Minnesota to use MRI-guided technology to make DBS surgery for epilepsy more precise, efficient

Final electrode location (right side) from the intraoperative MRI images taken during the procedure.

On June 28, 2022, functional neurosurgeon Michael C. Park, MD, PhD, performed the first deep brain stimulation (DBS) procedure in Minnesota that used the MRI-guided ClearPoint™ Neuro system. He was treating an epilepsy patient and found that the technology provided distinct advantages.

Using DBS to treat intractable epilepsy was approved by the FDA in 2018. The procedure delivers electrical stimulation to the anterior nucleus of the thalamus (ANT), a small brain structure involved in the spread of an initially localized seizure. “The ANT really can’t be mapped using electrophysiology to determine where you are when placing the electrodes,” said Park. “It’s a very small area in the brain – less than a centimeter in diameter.”

Michael C. Park MD PhDTricky procedure
Prior to using ClearPoint Neuro, these procedures could be tricky, according to Park (pictured here). “You would have to look at an image, pick a target, and place the electrode,” he explained. Unlike DBS procedures to treat movement disorders, the patient cannot be awake to help the neurosurgeon understand if the electrodes are positioned accurately. “If an epilepsy patient is awake during surgery, you might trigger a seizure,” said Park.

Pre-op, intra-op, and post-op CT scans and fluoroscopic X-ray images are also required during the typical DBS procedure for epilepsy. “That kind of imaging gives you indirect confirmation of where you are,” said Park. “The procedure takes a long time and is complicated to navigate, and in the end, you really don’t know where your electrode is with any degree of confidence.”

Making it more precise
With the ClearPoint Neuro system, Park used IMRIS intraoperative MRI, another advanced technology available to neurosurgery at University of Minnesota Medical Center, which makes the process much more precise and eventually, will reduce time in the OR. He can also use the ClearPoint Neuro system to plan his approach. “You can put in a cannula or a sheath to get to the target, insert a slender probe known as a stylet, which shows up on the MRI, confirm that’s where you want to go, and then place the electrode,” said Park. “You know where you are in real-time with no guessing. That’s ClearPoint Neuro’s advantage. It’s very accurate with little room for error relative to being off target.”

Department Head Clark C. Chen, MD, PhD, was using the ClearPoint Neuro system for brain tumor surgeries and recommended its use to Park. To learn how to use the system, Park went to Mayo Jacksonville in Florida to observe neurosurgeon Sanjeet Grewal, MD, who uses ClearPoint Neuro with intraoperative MRI on a regular basis.

Excited by the possibilities
As more people with epilepsy turn to DBS to manage their symptoms, Park is excited about the possibilities that ClearPoint Neuro gives him to improve patient outcomes. He and his surgical team have completed two surgeries using the technology and both patients are doing well. Additional procedures are being planned.

“Based on the first two cases, I really like the precision, accuracy, and real-time feedback from the intraoperative MRI,” said Park. “The technology isn’t too difficult to learn how to use, either. And as we become more proficient, I believe it will help us cut down surgery time.”

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