A simple stereotactic method for frameless deep brain stimulation.
BACKGROUND
Deep brain stimulation (DBS) is widely used to treat advanced Parkinson's disease, other movement and psychiatric disorders. DBS implantation requires application of a stereotactic frame throughout a lengthy procedure, making it uncomfortable and tiring. We designed a stereotactic cube to stage the operation, perform frameless microelectrode recording (MER) and fix the DBS.


METHODS
The 15-mm cube is implanted in a burr hole using bone cement. It contains 5 parallel trajectories (central + 4 around). It is aligned by stereotactic frame so that central trajectory reaches the target. Frameless MER is performed by attaching a micro-driver to the cube using 2-5 cannulae (4 cm). The DBS is fixed to the cube by a mini-plate and 1 screw. Ninety-six cubes were compared with 43 Bennet spheres (BS).


RESULTS
No cube moved compared to 2 (5%) BS (p < 0.05). The final trajectory was central in 64.4% of cubes compared to 47.5% of BS, and the final target was >2 mm out in no cubes compared to 12.5% of BS (p < 0.01). Infection and haemorrhage were observed in 2.5% and 3.3% of cubes, respectively, while 5% of BS developed infection, 5% haemorrhage and 7.5% skin erosion.


CONCLUSIONS
This method is simple and effective in staging DBS procedures, performing frameless MER and DBS implantation, fixation and revision.
Eljamel
M Sam
MS
Department of Neurosurgery, Ninewells Hospital and Medical School, Dundee, UK. m.s.eljamel@dundee.ac.uk
Tulley
Mark
M
Spillane
Kate
K
D000328:Adult; D000368:Aged; D046690:Deep Brain Stimulation / Q000295:instrumentation* / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008839:Microelectrodes; D008875:Middle Aged; D038361:Neuronavigation / Q000295:instrumentation / Q000379:methods*; D010300:Parkinson Disease / Q000473:pathology* / Q000628:therapy; D013238:Stereotaxic Techniques