Impact of Tissue Characteristics on Radio-Frequency Lesioning and Navigation in the Brain Simulation, experimental and clinical studies

Abstract: Radio-Frequency (RF) lesioning, or RF ablation, is a method that uses high frequency currents for thermal coagulation of pathological tissue or signal pathways. The current is delivered from an electrode, which also contains a temperature sensor permitting control of the current at a desired target temperature. In the brain, RF lesioning can e.g. be used for treatment of severe chronic pain and movement disorders such as Parkinson’s disease. This thesis focuses on modelling and simulation with the aim of gaining better understanding and predictability of the lesioning process in the central brain. The finite element method (FEM), together with experimental comparisons, was used to study the effects of electric and thermal conductivity, blood perfusion (Paper I), and cerebrospinal fluid (CSF) filled cysts (Paper II) on resulting lesion volume and shape in brain tissue. The influence of blood perfusion was modelled as an increase in thermal conductivity in non-coagulated tissue. This model gave smaller simulated lesions with increasing blood perfusion as heat was more efficiently conducted from the rim of the lesion. If the coagulation was not taken into consideration, the lesion became larger with increasing thermal conductivity instead, as the increase in conducted heat was compensated for through an increased power output in order to maintain the target temperature. Simulated lesions corresponded well to experimental in-vivo lesions. The electric conductivity in a homogeneous surrounding had little impact but this was not true for a heterogeneous surrounding. CSF has a much higher electric conductivity than brain tissue, which focused the current to the cyst if the electrode tip was in contact with both a cyst and brain tissue. Heating of CSF could also cause considerable convective flow and as a result a very efficient heat transfer. This affected both simulated and experimental lesion sizes and shapes. As a result both very large and very small lesions could be obtained depending on whether sufficient power was supplied or if the heating was mitigated over a large volume. Clinical (Paper IV) and experimental (Paper III) measurements were used for investigation of changes in reflected light intensity from undamaged and coagulating brain tissue respectively. Monte Carlo (MC) simulations for light transport were made for comparison (Paper V). For the optical measurements, an RF electrode with adjacent optical fibres was used and this electrode was also modelled for the optical simulations. According to the MC simulations, coagulation should make grey matter lighter and white matter darker, while thalamic light grey should remain approximately the same. Experiments in ex-vivo porcine tissue gave an increase in reflected light intensity from grey matter at approximately 50 °C but the signal was very variable and the isotherm 60 °C gave better agreement between simulated and experimental lesions. No consistent decrease in reflected light intensity could be seen during coagulation of white matter. Clinical measurements were performed during the creation of 21 trajectories for deep brain stimulation electrodes. In agreement with the simulations, reflected light intensity was found to differentiate well between undamaged grey, light grey and white matter. In conclusion, blood perfusion and CSF in particular may greatly affect the lesioning process and can be important to consider when planning surgery. Reflected light intensity seems unreliable for the detection of coagulation in light grey brain matter such as the thalamus. However, it seems very promising for navigation in the brain and for detection of coagulation in other tissue types such as muscle.