Experience with microelectrode guided subthalamic nucleus deep brain stimulation.
OBJECTIVE
Subthalamic deep brain stimulation (DBS) has rapidly become the standard surgical therapy for medically refractory Parkinson disease. However, in spite of its wide acceptance, there is considerable variability in the technical approach. This study details our technique and experience in performing microelectrode recording (MER) guided subthalamic nucleus (STN) DBS in the treatment of Parkinson disease.


METHODS
Forty patients underwent surgery for the implantation of 70 STN DBS electrodes. Stereotactic localization was performed using a combination of magnetic resonance and computed tomographic imaging. We used an array of three microelectrodes, separated by 2 mm, for physiological localization of the STN. The final location was selected based on MER and macrostimulation through the DBS electrode.


RESULTS
The trajectory selected for the DBS electrode had an average pass through the STN of 5.6 +/- 0.4 mm on the left and 5.7 +/- 0.4 mm on the right. The predicted location was used in 42% of the cases but was modified by MER in the remaining 58%. Patients were typically discharged on the second postoperative day. Eighty-five percent of patients were sent home, 13% required short-term rehabilitation, and one patient required long-term nursing services. Seven complications occurred over 4 years. Four patients suffered small hemorrhages, one patient experienced a lead migration, one developed an infection of the pulse generator, and one patient suffered from a superficial cranial infection.


CONCLUSIONS
Simultaneous bilateral MER-guided subthalamic DBS is a relatively safe and well-tolerated procedure. MER plays an important role in optimal localization of the DBS electrodes.
Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Ramin
R
Amirnovin
Ziv M
ZM
Williams
G Rees
GR
Cosgrove
Emad N
EN
Eskandar
D000368:Aged; D001931:Brain Mapping; D046690:Deep Brain Stimulation / Q000379:methods*; D004599:Electric Stimulation Therapy; D004567:Electrodes, Implanted; D005071:Evoked Potentials / Q000502:physiology / Q000528:radiation effects; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008839:Microelectrodes / Q000600:supply & distribution*; D008875:Middle Aged; D010300:Parkinson Disease / Q000601:surgery*; D013238:Stereotaxic Techniques; D020531:Subthalamic Nucleus / Q000601:surgery*; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome