Implantation of deep brain stimulators into the subthalamic nucleus: technical approach and magnetic resonance imaging-verified lead locations.
OBJECTIVE
Chronic deep brain stimulation (DBS) of the subthalamic nucleus (STN) is a procedure that is rapidly gaining acceptance for the treatment of symptoms in patients with Parkinson disease (PD), but there are few detailed descriptions of the surgical procedure itself. The authors present the technical approach used to implant 76 stimulators into the STNs of patients with PD and the lead locations, which were verified on postoperative magnetic resonance (MR) images.


METHODS
Implantation procedures were performed with the aid of stereotactic MR imaging, microelectrode recording (MER) in the region of the stereotactic target to define the motor area of the STN, and intraoperative test stimulation to assess the thresholds for stimulation-induced adverse effects. All patients underwent postoperative MR imaging, which was performed using volumetric gradient-echo and T2-weighted fast-spin echo techniques, computational reformatting of the MR image into standard anatomical planes, and quantitative measurements of lead location with respect to the midcommissural point and the red nucleus. Lead locations were statistically correlated with physiological data obtained during MER and intraoperative test stimulation.


CONCLUSIONS
The authors' approach to implantation of DBS leads into the STN was associated with consistent lead placement in the dorsolateral STN, a low rate of morbidity, efficient use of operating room time, and robust improvement in motor function. The mean coordinates of the middle of the electrode array, measured on postoperative MR images, were 11.6 mm lateral, 2.9 mm posterior, and 4.7 mm inferior to the midcommissural point, and 6.5 mm lateral and 3.5 mm anterior to the center of the red nucleus. Voltage thresholds for several types of stimulation-induced adverse effects were predictive of lead location. Technical nuances of the surgery are described in detail.
Starr
Philip A
PA
Department of Neurological Surgery, University of California, San Francisco 94143, USA. starrp@itsa.ucsf.edu
Christine
Chadwick W
CW
Theodosopoulos
Philip V
PV
Lindsey
Nadja
N
Byrd
Deborah
D
Mosley
Anthony
A
Marks
William J
WJ
D000368:Aged; D004599:Electric Stimulation Therapy; D004567:Electrodes, Implanted; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D019635:Neurosurgical Procedures; D017063:Outcome Assessment, Health Care; D010300:Parkinson Disease / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery*; D011182:Postoperative Care; D012189:Retrospective Studies; D013238:Stereotaxic Techniques; D020531:Subthalamic Nucleus / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery*