title: A Comparison of Unilateral Deep Brain Stimulation (DBS), Simultaneous Bilateral DBS, and Staged Bilateral DBS Lead Accuracies.
abstract: BACKGROUND
  Accuracy of lead placement within the brain can affect the outcome of deep brain stimulation (DBS) surgery. Whether performing unilateral lead implantation, simultaneous bilateral lead implantation, or staged bilateral lead implantation affects accuracy has not yet been assessed. We compare lead placement errors to evaluate whether one approach affords greater lead accuracy.
  
  
  METHODS
  We retrospectively reviewed 205 leads placed in 125 DBS surgeries. The accuracy of lead placement, defined by differences in x, y, and z coordinates and error vector magnitudes, was compared between three surgery groups: unilateral leads, bilateral leads placed simultaneously, and bilateral leads placed in staged surgeries. We also compared accuracies between first and second leads within each bilateral cohort and between second leads of the bilateral cohorts. Finally, we examined the effect of target and age on accuracy.
  
  
  RESULTS
  The accuracy of lead placement was comparable among unilateral, simultaneous bilateral, and staged bilateral leads. Timing of placement of the second lead in bilateral cases was not found to affect accuracy. The mean number of microelectrode trajectories was greater for first leads in simultaneous bilateral DBS (p = 0.032). No significant correlation between either age or target and accuracy was found.
  
  
  CONCLUSIONS
  Although there may be other important reasons for performing DBS in a staged fashion, our study finds that neither laterality nor timing of second lead placement, patient age, or target site have significant impact on DBS lead accuracy, a finding that indicates with appropriate approach selection based on patient factors, accuracy does not have to be significantly compromised.
authors.affiliation: Department of Neurosurgery, Albany Medical Center, Albany, NY, USA.
authors.forename: Sophia
authors.initials: S
authors.lastname: Peng
authors.affiliation: Department of Neurosurgery, Albany Medical Center, Albany, NY, USA.
authors.forename: David
authors.initials: D
authors.lastname: Levine
authors.affiliation: Department of Neurology, Albany Medical Center, Albany, NY, USA.
authors.forename: Adolfo
authors.initials: A
authors.lastname: Ramirez-Zamora
authors.affiliation: Department of Neurosurgery, Albany Medical Center, Albany, NY, USA.
authors.forename: Arun
authors.initials: A
authors.lastname: Chockalingam
authors.affiliation: Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Feustel
authors.affiliation: Department of Neurology, Albany Medical Center, Albany, NY, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Durphy
authors.affiliation: Department of Neurology, Albany Medical Center, Albany, NY, USA.
authors.forename: Era
authors.initials: E
authors.lastname: Hanspal
authors.affiliation: Department of Neurology, University of Massachusetts, Worchester, MA, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Novak
authors.affiliation: Department of Neurosurgery, Albany Medical Center, Albany, NY, USA.|Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA.
authors.forename: Julie G
authors.initials: JG
authors.lastname: Pilitsis
mesh_terms: D000368:Aged; D015331:Cohort Studies; D046690:Deep Brain Stimulation / Q000295:instrumentation / Q000379:methods* / Q000592:standards*; D004567:Electrodes, Implanted / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000000981:diagnostic imaging / Q000601:surgery*; D012189:Retrospective Studies; D020531:Subthalamic Nucleus / Q000000981:diagnostic imaging / Q000601:surgery*
keywords: Deep brain stimulation; lead accuracy; microelectrode recording; simultaneous bilateral; staged bilateral; unilateral