{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T08:59:18Z","timestamp":1785488358615,"version":"3.56.0"},"reference-count":25,"publisher":"Scientific Scholar","content-domain":{"domain":["surgicalneurologyint.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:sec id=\"st1\">\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Parkinson\u2019s disease (PD) is characterized by dopaminergic neuron loss, causing motor symptoms such as bradykinesia and tremor. Deep-brain stimulation (DBS) targeting the subthalamic nucleus or internal globus pallidus is a standard treatment for advanced stages. However, intraoperative factors such as pneumocephalus and cerebrospinal fluid leakage can induce brain shift, potentially compromising electrode placement. This study investigated the relationships between pneumocephalus, cerebral atrophy, and brain shift.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"st2\">\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>A retrospective review was conducted on PD patients who underwent DBS. Pneumocephalus and total intracranial volume (TIV) were segmented from postoperative computed tomography scans using 3D Slicer, while brain volume was calculated through Computational Anatomy Toolbox (CAT12). The brain index was defined as brain volume\/TIV. Associations were analyzed using multiple linear regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"st3\">\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Thirty-eight patients were included (45 surgeries; 70% male). Mean electrode tip displacement was 1.11 mm (standard deviation [SD] = 3.43), 0.75 mm (SD = 0.86), and 0.54 mm (SD = 1.70) along the x, y, and z axes, respectively. The regression model explained 42.8% of the variance in pneumocephalus (adjusted R\n                      <jats:sup>2<\/jats:sup>\n                      = 0.355;\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.001). TIV (\u03b2 = \u22120.497;\n                      <jats:italic>p<\/jats:italic>\n                      = 0.011), procedure duration (\u03b2 = 0.361,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.011) and female sex (\n                      <jats:italic>p<\/jats:italic>\n                      = 0.001) were significant predictors. Conversely, brain index (\n                      <jats:italic>p<\/jats:italic>\n                      = 0.651) and DBS target (\n                      <jats:italic>p<\/jats:italic>\n                      = 0.284) showed no significant association.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"st4\">\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Pneumocephalus after DBS is influenced by total cranial volume, surgical duration, and sex. While brain atrophy was not a predictor. Pneumocephalus causes linear and angular brain shift, affecting electrode positioning across axes. These findings may inform strategies to enhance surgical precision.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.25259\/sni_50_2026","type":"journal-article","created":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T08:22:37Z","timestamp":1785486157000},"page":"431","update-policy":"https:\/\/doi.org\/10.25259\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Pneumocephalus after deep brain stimulation in Parkinson\u2019s disease: The role of brain volume in brain shift"],"prefix":"10.25259","volume":"17","author":[{"given":"Ana Vict\u00f3ria Calado Godoy Carlos","family":"de Lima","sequence":"first","affiliation":[{"name":"Faculty of Medicine, Santo Amaro University, S\u00e3o Paulo, Brazil"},{"name":"Department of Neurology and Neurosurgery, Federal University of Sao Paulo, S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonardo Favi","family":"Bocca","sequence":"additional","affiliation":[{"name":"Department of Neurology and Neurosurgery, Federal University of Sao Paulo, S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renato Barradas","family":"Rodrigues","sequence":"additional","affiliation":[{"name":"Department of Neurology and Neurosurgery, Federal University of Sao Paulo, S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thiago Pereira","family":"Rodrigues","sequence":"additional","affiliation":[{"name":"Department of Neurology and Neurosurgery, Federal University of Sao Paulo, S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolina Candeias","family":"da Silva","sequence":"additional","affiliation":[{"name":"Department of Neurology and Neurosurgery, Federal University of Sao Paulo, S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ernandez Rodrigues dos","family":"Santos","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Imaging, Federal University of Sao Paulo, S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ricardo Silva","family":"Centeno","sequence":"additional","affiliation":[{"name":"Department of Neurology and Neurosurgery, Federal University of Sao Paulo, S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10894","published-online":{"date-parts":[[2026,7,31]]},"reference":[{"key":"10.25259\/SNI_50_2026\/ref-1","doi-asserted-by":"crossref","first-page":"2033","DOI":"10.1016\/j.neuroimage.2010.09.025","article-title":"A reproducible evaluation of ANTs similarity metric performance in brain image registration","volume":"54","author":"Avants","year":"2011","journal-title":"Neuroimage"},{"key":"10.25259\/SNI_50_2026\/ref-2","doi-asserted-by":"crossref","first-page":"246","DOI":"10.1159\/000327916","article-title":"Intracranial 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