title: Frameless deep brain stimulation surgery: a community hospital experience.
abstract: OBJECTIVE
  Frame-based stereotaxy has regularly been utilized for deep brain stimulation (DBS) surgery. More recently, frameless neuronavigation has revealed similar outcomes for functional neurosurgical operations. Such comparable outcomes have been described by tertiary referral centers, but whether such excellent surgical outcomes are attainable in a community setting has yet to be reported.
  
  
  METHODS
  Eighteen patients received frameless DBS surgery, 11 with subthalmic nucleus (STN) implantation for Parkinson's disease (PD) and 7 with ventral intermediate nucleus (Vim) implantation for essential tremor (ET). Their data was collected and analyzed, including the Unified Parkinson's Disease Rating Scale (UPDRS) and tremor scores.
  
  
  RESULTS
  There was a 58% reduction in UPDRS III and a 47% reduction in overall levodopa dose in those with STN DBS (p<0.0001 and p<0.0005, respectively) and those with Vim DBS had a 76% improvement in their overall tremor rating score (p<0.002) at mean follow-up (8.2 and 10.1 months, respectively). No intraoperative complications occurred. Two subjects developed wound dehiscence post-operatively and another had fall-induced lead fracture, all treated with uncomplicated hardware replacement.
  
  
  CONCLUSIONS
  Frameless DBS for PD and ET can be safely performed in a community setting with similar excellent outcomes as those of larger academic centers as well as clinical results comparable to frame-based surgery. Patients living in community or rural areas may not need to travel across city or even state lines to receive this surgical option, especially if they have the opportunity to receive it closer to home.
authors.affiliation: New Jersey Neuroscience Institute, JFK Medical Center, Edison, NJ 08818, USA. pzahos@meridianhealth.com
authors.forename: Peter A
authors.initials: PA
authors.lastname: Zahos
authors.forename: Faris
authors.initials: F
authors.lastname: Shweikeh
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000978:Antiparkinson Agents / Q000627:therapeutic use; D001921:Brain / Q000601:surgery*; D003627:Data Interpretation, Statistical; D046690:Deep Brain Stimulation / Q000379:methods*; D020329:Essential Tremor / Q000209:etiology / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006764:Hospitals, Community; D006801:Humans; D007980:Levodopa / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D010300:Parkinson Disease / Q000503:physiopathology / Q000601:surgery; D016896:Treatment Outcome
chemical_list: D000978:Antiparkinson Agents; D007980:Levodopa