title: A simple stereotactic method for frameless deep brain stimulation.
abstract: 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.
authors.affiliation: Department of Neurosurgery, Ninewells Hospital and Medical School, Dundee, UK. m.s.eljamel@dundee.ac.uk
authors.forename: M Sam
authors.initials: MS
authors.lastname: Eljamel
authors.forename: Mark
authors.initials: M
authors.lastname: Tulley
authors.forename: Kate
authors.initials: K
authors.lastname: Spillane
mesh_terms: 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