Procedural Variables Influencing Stereotactic Accuracy and Efficiency in Deep Brain Stimulation Surgery.

Department

Neurosurgery; Neuroradiology

Document Type

Article

Abstract

BACKGROUND: Deep brain stimulation (DBS) is well-established, evidence-based therapy for Parkinson disease, essential tremor, and primary dystonia. Clinical outcome studies have recently shown that "asleep" DBS lead placement, performed using intraoperative imaging with stereotactic accuracy as the surgical endpoint, has motor outcomes comparable to traditional "awake" DBS using microelectrode recording (MER), but with shorter case times and improved speech fluency.

OBJECTIVE: To identify procedural variables in DBS surgery associated with improved surgical efficiency and stereotactic accuracy.

METHODS: Retrospective review of 323 cases with 546 leads placed (August 2011-October 2014). In 52% (n = 168) of cases, patients were asleep under general anesthesia without MER. Multivariate regression identified independent predictors of reduced surgery time and improved stereotactic accuracy.

RESULTS: MER was an independent contributor to increased procedure time (+44 min; P = .03). Stereotactic accuracy was better in asleep patients. Accuracy was improved with frame-based stereotaxy at head of bed 0° vs frameless stereotaxy at head of bed 30°. Improved accuracy was also associated with shorter procedures (r = 0.17; P = .049). Vector errors were evenly distributed around the planned target for the globus pallidus internus, but directionally skewed for the subthalamic (medial-posterior) and ventral intermediate nuclei (medial-anterior).

CONCLUSION: Distinct procedural variables in DBS surgery are associated with reduced case times and improved stereotactic accuracy.

Medical Subject Headings

Adult; Aged; Aged, 80 and over; Deep Brain Stimulation; Female; Globus Pallidus; Humans; Male; Microelectrodes; Middle Aged; Movement Disorders; Neurosurgical Procedures; Retrospective Studies; Stereotaxic Techniques; Subthalamic Nucleus; Treatment Outcome; Young Adult

Publication Date

7-1-2019

Publication Title

Oper Neurosurg (Hagerstown)

ISSN

2332-4260

Volume

17

Issue

1

First Page

70

Last Page

78

PubMed ID

30339204

Digital Object Identifier (DOI)

10.1093/ons/opy291

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