title: Simultaneous bilateral stereotactic procedure for deep brain stimulation implants: a significant step for reducing operation time.
abstract: OBJECT Currently, bilateral procedures involve 2 sequential implants in each of the hemispheres. The present report demonstrates the feasibility of simultaneous bilateral procedures during the implantation of deep brain stimulation (DBS) leads. METHODS Fifty-seven patients with movement disorders underwent bilateral DBS implantation in the same study period. The authors compared the time required for the surgical implantation of deep brain electrodes in 2 randomly assigned groups. One group of 28 patients underwent traditional sequential electrode implantation, and the other 29 patients underwent simultaneous bilateral implantation. Clinical outcomes of the patients with Parkinson's disease (PD) who had undergone DBS implantation of the subthalamic nucleus using either of the 2 techniques were compared. RESULTS Overall, a reduction of 38.51% in total operating time for the simultaneous bilateral group (136.4 ± 20.93 minutes) as compared with that for the traditional consecutive approach (220.3 ± 27.58 minutes) was observed. Regarding clinical outcomes in the PD patients who underwent subthalamic nucleus DBS implantation, comparing the preoperative off-medication condition with the off-medication/on-stimulation condition 1 year after the surgery in both procedure groups, there was a mean 47.8% ± 9.5% improvement in the Unified Parkinson's Disease Rating Scale Part III (UPDRS-III) score in the simultaneous group, while the sequential group experienced 47.5% ± 15.8% improvement (p = 0.96). Moreover, a marked reduction in the levodopa-equivalent dose from preoperatively to postoperatively was similar in these 2 groups. The simultaneous bilateral procedure presented major advantages over the traditional sequential approach, with a shorter total operating time. CONCLUSIONS A simultaneous stereotactic approach significantly reduces the operation time in bilateral DBS procedures, resulting in decreased microrecording time, contributing to the optimization of functional stereotactic procedures.
authors.affiliation: Division of Functional Neurosurgery of Institute of Psychiatry, Department of Neurology, University of São Paulo Medical School; and.|Laboratory of Neuromodulation, Institute of Teaching and Research, Hospital Sirio-Libanês, São Paulo, Brazil.
authors.forename: Erich Talamoni
authors.initials: ET
authors.lastname: Fonoff
authors.affiliation: Division of Functional Neurosurgery of Institute of Psychiatry, Department of Neurology, University of São Paulo Medical School; and.
authors.forename: Angelo
authors.initials: A
authors.lastname: Azevedo
authors.affiliation: Division of Functional Neurosurgery of Institute of Psychiatry, Department of Neurology, University of São Paulo Medical School; and.
authors.forename: Jairo Silva Dos
authors.initials: JS
authors.lastname: Angelos
authors.affiliation: Laboratory of Neuromodulation, Institute of Teaching and Research, Hospital Sirio-Libanês, São Paulo, Brazil.
authors.forename: Raquel Chacon Ruiz
authors.initials: RC
authors.lastname: Martinez
authors.affiliation: Division of Functional Neurosurgery of Institute of Psychiatry, Department of Neurology, University of São Paulo Medical School; and.
authors.forename: Jessie
authors.initials: J
authors.lastname: Navarro
authors.affiliation: Division of Functional Neurosurgery of Institute of Psychiatry, Department of Neurology, University of São Paulo Medical School; and.
authors.forename: Paul Rodrigo
authors.initials: PR
authors.lastname: Reis
authors.affiliation: Division of Functional Neurosurgery of Institute of Psychiatry, Department of Neurology, University of São Paulo Medical School; and.
authors.forename: Miguel Ernesto San Martin
authors.initials: ME
authors.lastname: Sepulveda
authors.affiliation: Division of Functional Neurosurgery of Institute of Psychiatry, Department of Neurology, University of São Paulo Medical School; and.
authors.forename: Rubens Gisbert
authors.initials: RG
authors.lastname: Cury
authors.affiliation: Division of Functional Neurosurgery of Institute of Psychiatry, Department of Neurology, University of São Paulo Medical School; and.
authors.forename: Maria Gabriela Dos Santos
authors.initials: MG
authors.lastname: Ghilardi
authors.affiliation: Division of Functional Neurosurgery of Institute of Psychiatry, Department of Neurology, University of São Paulo Medical School; and.
authors.forename: Manoel Jacobsen
authors.initials: MJ
authors.lastname: Teixeira
authors.affiliation: Division of Functional Neurosurgery of Institute of Psychiatry, Department of Neurology, University of São Paulo Medical School; and.
authors.forename: William Omar Contreras
authors.initials: WO
authors.lastname: Lopez
mesh_terms: D000368:Aged; D046690:Deep Brain Stimulation; D004567:Electrodes, Implanted; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010300:Parkinson Disease / Q000628:therapy*; D013238:Stereotaxic Techniques; D020531:Subthalamic Nucleus / Q000601:surgery*; D016896:Treatment Outcome
keywords: DBS = deep brain stimulation; GPi = globus pallidus internus; PD = Parkinson's disease; Parkinson disease; STN = subthalamic nucleus; UPDRS-III = Unified Parkinson's Disease Rating Scale Part III; Vim = ventralis intermedius nucleus; brain shift; deep brain stimulation; functional neurosurgery; microelectrode recording; movement disorders