title: Does the Use of Intraoperative Microelectrode Recording Influence the Final Location of Lead Implants in the Ventral Intermediate Nucleus for Deep Brain Stimulation?
abstract: To determine if the use of intraoperative microelectrode recording (MER) influences the final location of lead implant in deep brain stimulation (DBS) of the ventral intermediate nucleus (VIM), and to evaluate the incidence of associated complications. The usefulness of intraoperative MER in DBS is debated, some centers suggesting it increases complications without additional benefit. We conducted a retrospective chart review of all patients who underwent VIM DBS with MER at the University of Texas Health Science Center in Houston from June 1, 2009 to October 1, 2013. Initial (MRI determined) and final (intraoperative MER determined) coordinates of implant were compared. To assess incidences of hemorrhagic and infectious complications, we reviewed postoperative CT scans and follow-up notes. Forty-five lead implants on 24 patients were reviewed. The mean age at implantation was 62.42 years (range 18-83). The average duration from diagnosis to surgery was 21.5 years (range 1-52). A statistically significant mean difference was observed in the superior-inferior plane (0.52 ± 0.80 mm inferiorly, p < 0.05) and the anterior-posterior plane (0.45 ± 0.86 mm posteriorly, p < 0.05). A non-statistically significant difference was also observed in the medial-lateral plane (0.02± 0.15 mm, p > 0.05). One patient developed an infectious complication (4.2 %) that required removal of leads; two patients had minimal asymptomatic intra-ventricular bleeding (8.3 %). In our DBS center, intraoperative MER in VIM DBS implant does not seem to have a higher rate of surgical complications compared to historical series not using MER, and might also be useful in determining the final lead location.
authors.affiliation: University of Texas Health Science Center at Houston, Houston, TX, USA.
authors.forename: Sujan
authors.initials: S
authors.lastname: Reddy
authors.affiliation: University of Texas Health Science Center at Houston, Houston, TX, USA.
authors.forename: Albert
authors.initials: A
authors.lastname: Fenoy
authors.affiliation: University of Texas Health Science Center at Houston, Houston, TX, USA.
authors.forename: Erin
authors.initials: E
authors.lastname: Furr-Stimming
authors.affiliation: University of Texas Health Science Center at Houston, Houston, TX, USA.
authors.forename: Mya
authors.initials: M
authors.lastname: Schiess
authors.affiliation: University of Texas Health Science Center at Houston, Houston, TX, USA. raja.mehanna@uth.tmc.edu.
authors.forename: Raja
authors.initials: R
authors.lastname: Mehanna
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D046690:Deep Brain Stimulation; D005500:Follow-Up Studies; D006801:Humans; D064795:Intraoperative Neurophysiological Monitoring / Q000009:adverse effects / Q000379:methods; D008839:Microelectrodes; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods; D011183:Postoperative Complications; D012189:Retrospective Studies; D016896:Treatment Outcome; D020651:Ventral Thalamic Nuclei / Q000503:physiopathology*; D055815:Young Adult
keywords: Deep brain stimulation; Microelectrode recoding; Tremors; Ventral intermediate nucleus