{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T16:13:58Z","timestamp":1792426438616,"version":"4.5.0"},"reference-count":37,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,11]]},"abstract":"<jats:sec><jats:title>OBJECTIVE<\/jats:title><jats:p>Lead placement for deep brain stimulation (DBS) using intraoperative MRI (iMRI) relies solely on real-time intraoperative neuroimaging to guide electrode placement, without microelectrode recording (MER) or electrical stimulation. There is limited information, however, on outcomes after iMRI-guided DBS for dystonia. The authors evaluated clinical outcomes and targeting accuracy in patients with dystonia who underwent lead placement using an iMRI targeting platform.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>Patients with dystonia undergoing iMRI-guided lead placement in the globus pallidus pars internus (GPi) were identified. Patients with a prior ablative or MER-guided procedure were excluded from clinical outcomes analysis. Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) scores and Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) scores were assessed preoperatively and at 6 and 12 months postoperatively. Other measures analyzed include lead accuracy, complications\/adverse events, and stimulation parameters.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>A total of 60 leads were implanted in 30 patients. Stereotactic lead accuracy in the axial plane was 0.93 \u00b1 0.12 mm from the intended target. Nineteen patients (idiopathic focal, n = 7; idiopathic segmental, n = 5; DYT1, n = 1; tardive, n = 2; other secondary, n = 4) were included in clinical outcomes analysis. The mean improvement in BFMDRS score was 51.9% \u00b1 9.7% at 6 months and 63.4% \u00b1 8.0% at 1 year. TWSTRS scores in patients with predominant cervical dystonia (n = 13) improved by 53.3% \u00b1 10.5% at 6 months and 67.6% \u00b1 9.0% at 1 year. Serious complications occurred in 6 patients (20%), involving 8 of 60 implanted leads (13.3%). The rate of serious complications across all patients undergoing iMRI-guided DBS at the authors\u2019 institution was further reviewed, including an additional 53 patients undergoing GPi-DBS for Parkinson disease. In this expanded cohort, serious complications occurred in 11 patients (13.3%) involving 15 leads (10.1%).<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>Intraoperative MRI\u2013guided lead placement in patients with dystonia showed improvement in clinical outcomes comparable to previously reported results using awake MER-guided lead placement. The accuracy of lead placement was high, and the procedure was well tolerated in the majority of patients. However, a number of patients experienced serious adverse events that were attributable to the introduction of a novel technique into a busy neurosurgical practice, and which led to the revision of protocols, product inserts, and on-site training.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2019.6.jns19548","type":"journal-article","created":{"date-parts":[[2019,10,12]],"date-time":"2019-10-12T00:11:58Z","timestamp":1570839118000},"page":"1582-1594","source":"Crossref","is-referenced-by-count":9,"title":["Clinical outcomes of pallidal deep brain stimulation for dystonia implanted using intraoperative MRI"],"prefix":"10.3171","volume":"133","author":[{"given":"Vibhash D.","family":"Sharma","sequence":"first","affiliation":[{"name":"Departments of Neurology and"},{"name":"Departments of Neurology and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yarema B.","family":"Bezchlibnyk","sequence":"additional","affiliation":[{"name":"Neurosurgery, Emory University School of Medicine, Atlanta, Georgia;"},{"name":"Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, Florida; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Faical","family":"Isbaine","sequence":"additional","affiliation":[{"name":"Neurosurgery, Emory University School of Medicine, Atlanta, Georgia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kushal B.","family":"Naik","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Cheng","sequence":"additional","affiliation":[{"name":"Neurosurgery, Emory University School of Medicine, Atlanta, Georgia;"},{"name":"Neurosurgery, University of Kansas Medical Center, Kansas City, Kansas;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John T.","family":"Gale","sequence":"additional","affiliation":[{"name":"Neurosurgery, Emory University School of Medicine, Atlanta, Georgia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Svjetlana","family":"Miocinovic","sequence":"additional","affiliation":[{"name":"Departments of Neurology and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cathrin","family":"Buetefisch","sequence":"additional","affiliation":[{"name":"Departments of Neurology and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stewart A.","family":"Factor","sequence":"additional","affiliation":[{"name":"Departments of Neurology and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jon T.","family":"Willie","sequence":"additional","affiliation":[{"name":"Departments of Neurology and"},{"name":"Neurosurgery, Emory University School of Medicine, Atlanta, Georgia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas M.","family":"Boulis","sequence":"additional","affiliation":[{"name":"Neurosurgery, Emory University School of Medicine, Atlanta, Georgia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Wichmann","sequence":"additional","affiliation":[{"name":"Departments of Neurology and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahlon R.","family":"DeLong","sequence":"additional","affiliation":[{"name":"Departments of Neurology and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert E.","family":"Gross","sequence":"additional","affiliation":[{"name":"Departments of Neurology and"},{"name":"Neurosurgery, Emory University School of Medicine, Atlanta, Georgia;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1","series-title":"J Neurol Neurosurg Psychiatry","doi-asserted-by":"publisher","first-page":"1383","DOI":"10.1136\/jnnp.2010.207993","article-title":"Which patients with dystonia benefit from deep brain stimulation? 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