Intraoperative x-ray to measure distance between DBS leads: A reliability study

Leo Verhagen Metman*, Julie G. Pilitsis, Glenn T. Stebbins, Maarten Bot, Roy A.E. Bakay

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


Background: Many factors can jeopardize the accuracy of deep brain stimulation (DBS) lead placement. Confirmation of lead placement while the patient is still in the operating room would be advantageous. Intraoperative MRI or CT can identify placement errors, but these modalities can be cost- or time prohibitive. Intraoperative fluoroscopy may give information on the accuracy of the Y coordinate, but the accuracy of the X coordinate usually cannot be confirmed. When an object of known dimensions is present in the brain, such as a unilateral DBS lead, its dimensions can be used to calculate unknown distances. The objective of this study was to determine if intraoperative AP skull x-ray accurately predicts the distance between DBS electrodes using postoperative MRI as the gold standard. Methods:: The distance between 32 pairs of DBS leads was measured by 2 independent raters under blinded conditions on intraoperative AP x-ray and postoperative axial and coronal MRI. Variable x-ray magnification was accounted for using the formula: actual distance between 2 leads = (measured distance between DBS leads)/(average measured length of electrodes) × 7.5 mm. Results:: The mean (± SD) distance on x-ray was 22.62 ± 2.23 mm, on axial MRI 22.78 ± 1.90 mm, and on coronal MRI 22.79 ± 2.00 mm. ANOVA revealed no difference based on method (P = .887) or raters (P = .940). The intraclass correlation coefficient showed excellent interrater reliability, Conclusions:: Intraoperative AP x-ray accurately predicts the distance between DBS leads. The technique is especially useful when the location of the first DBS lead relative to the midline is known, such as during staged bilateral procedures or lead replacement procedures.

Original languageEnglish (US)
Pages (from-to)1056-1059
Number of pages4
JournalMovement Disorders
Issue number8
StatePublished - Jul 2012


  • AP skull
  • DBS
  • Deep brain stimulation
  • Intraoperative imaging
  • MRI
  • Parkinson's disease
  • STN
  • Subthalamic nucleus
  • X-ray

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology


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