Electrode position determined by fused images of preoperative and postoperative magnetic resonance imaging and surgical outcome after subthalamic nucleus deep brain stimulation.
OBJECTIVE
The electrode position is important to the surgical outcome after subthalamic nucleus (STN) deep brain stimulation (DBS). The aim of this study was to compare the surgical outcome of bilateral STN DBS with the electrode position estimated using fused magnetic resonance imaging.


METHODS
Bilateral STN DBS was performed in 60 patients with advanced Parkinson's disease. Patients were evaluated with the Unified Parkinson's Disease Rating Scale, Hoehn and Yahr staging, Schwab and England Activities of Daily Living, L-dopa equivalent dose, and Short Form-36 Health Survey before and at 3 and 6 months after surgery. Brain magnetic resonance imaging (1.5-T) was performed in 53 patients at 6 months after STN DBS. The electrode position was estimated in the fused pre- and postoperative magnetic resonance images and correlated with the surgical results.


RESULTS
As a group, the Unified Parkinson's Disease Rating Scale, Hoehn and Yahr staging, Schwab and England Activities of Daily Living, and Short Form-36 Health Survey scores improved at 3 and 6 months after STN DBS. The L-dopa equivalent dose decreased by 60% at 3 and 6 months after STN DBS. The electrode position was divided into 6 types according to its relationship to the STN and the red nucleus. Most off-medication Unified Parkinson's Disease Rating Scale motor subscale scores improved regardless of the type of electrode position. The off-medication speech subscale score improved only in the patients whose electrodes were correctly positioned in the STN bilaterally.


CONCLUSIONS
The electrodes accurately positioned in the STN led to improved speech after bilateral STN DBS. An effort should be made in each patient to document the electrode position to monitor surgical performance and to improve the surgical outcome after STN DBS.
Paek
Sun Ha
SH
Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Republic of Korea. paeksh@snu.ac.kr
Han
Jung Ho
JH
Lee
Jee-Young
JY
Kim
Cheolyoung
C
Jeon
Beom Seok
BS
Kim
Dong Gyu
DG
D000328:Adult; D000368:Aged; D000978:Antiparkinson Agents / Q000627:therapeutic use; D046690:Deep Brain Stimulation / Q000009:adverse effects / Q000295:instrumentation*; D004567:Electrodes, Implanted; D005260:Female; D007839:Functional Laterality; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D007980:Levodopa / Q000627:therapeutic use; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods; D010300:Parkinson Disease / Q000175:diagnosis / Q000601:surgery / Q000628:therapy*; D012720:Severity of Illness Index; D013064:Speech Disorders / Q000175:diagnosis / Q000209:etiology; D020531:Subthalamic Nucleus / Q000473:pathology* / Q000601:surgery; D016896:Treatment Outcome
D000978:Antiparkinson Agents; D007980:Levodopa