The Role of Tissue Expansion in Deep Brain Stimulation Surgery for Parkinson's Disease

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Nikhil Thakur ◽  
Michael Eibach ◽  
Shahram Ghanaati ◽  
Volker Seifert ◽  
Gerhard Marquardt ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Tissue Expansion ◽  
Frameless Stereotaxy ◽  
Neurosurgical Procedures ◽  
Scalp Defects ◽  
Rotational Flap ◽  
Deep Brain Stimulation Surgery ◽  
Deep Brain

Abstract INTRODUCTION Scalp defects (SD) after neurosurgical-procedures in patients with Parkinson's disease (PD) are challenging especially when implants like DBS-leads lie underneath. Tissue expanders (TE) have been widely used in reconstructive surgery. The scanty neurosurgical literature on this topic deals with reconstruction after trauma/multiple craniotomies for neuro-oncological cases. The use of TE for complicated DBS cases has not yet been reported. We illustrate this use with the case of a 60-yr-old male patient. METHODS A patient with bilateral STN-DBS for idiopathic PD had undergone a total of 6 revision-procedures due to infections both at the impulse generator (IPG)-site and on the scalp above the DBS-electrodes. Both had to be eventually explanted due to bacterial contamination with an open frontal SD. Worsening of the QoL deemed re-implantation necessary. Occipital implantation of a 200 mL Polytech-TE was followed by gradual tissue expansion in 10 mL-steps over 7 mo with concomitant antibiotics. This was followed by TE-removal, DBS-re-implantation, and rotational-flap-mobilization providing strain-free scalp-closure. RESULTS Strain-free scalp closure was possible. Planning and carrying out of the DBS was not impeded by the MRI-compatible TE. Combining the DBS-re-implantation and TE-removal during a single general anesthesia (GA) proved feasible. The wound-healing at 180 d was optimal. CONCLUSION TEs are feasible for challenging DBS cases with large SDs. There are many important considerations including MRI-compatibility and TE-placement being conducive to frame-based or frameless stereotaxy. Interdisciplinary boards for such cases are indispensable.

Involvement of Subcortical Structures in the Preparation of Self-Paced Movement

2004 ◽  
Vol 18 (2/3) ◽  
pp. 130-139 ◽  
Author(s):  
Guillermo Paradiso ◽  
Danny Cunic ◽  
Robert Chen
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Basal Ganglia ◽  
Onset Time ◽  
Movement Planning ◽  
Movement Preparation ◽  
Subcortical Structures ◽  
Postoperative Mri ◽  
Deep Brain

Abstract Although it has long been suggested that the basal ganglia and thalamus are involved in movement planning and preparation, there was little direct evidence in humans to support this hypothesis. Deep brain stimulation (DBS) is a well-established treatment for movement disorders such as Parkinson's disease, tremor, and dystonia. In patients undergoing DBS surgery, we recorded simultaneously from scalp contacts and from electrodes surgically implanted in the subthalamic nucleus (STN) of 13 patients with Parkinson's disease and in the “cerebellar” thalamus of 5 patients with tremor. The aim of our studies was to assess the role of the cortico-basal ganglia-thalamocortical loop through the STN and the cerebello-thalamocortical circuit through the “cerebellar” thalamus in movement preparation. The patients were asked to perform self-paced wrist extension movements. All subjects showed a cortical readiness potential (RP) with onset ranging between 1.5 to 2s before the onset of movement. Subcortical RPs were recorded in 11 of 13 with electrodes in the STN and in 4 of 5 patients with electrodes in the thalamus. The onset time of the STN and thalamic RPs were not significantly different from the onset time of the scalp RP. The STN and thalamic RPs were present before both contralateral and ipsilateral hand movements. Postoperative MRI studies showed that contacts with maximum RP amplitude generally were inside the target nucleus. These findings indicate that both the basal ganglia and the cerebellar circuits participate in movement preparation in parallel with the cortex.

Temporary confusion syndrome after deep brain stimulation surgery in Parkinson's disease

Basal Ganglia ◽  
2013 ◽  
Vol 3 (1) ◽  
pp. 56
Author(s):  
S. Johannes ◽  
A. Keßler ◽  
P. Fricke ◽  
R.-I. Ernestus ◽  
F. Steigerwald ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Deep Brain Stimulation Surgery ◽  
Deep Brain

scholarly journals The Prevalence of Fatigue Following Deep Brain Stimulation Surgery in Parkinson's Disease and Association with Quality of Life

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Benzi M. Kluger ◽  
Veronica Parra ◽  
Charles Jacobson ◽  
Cynthia W. Garvan ◽  
Ramon L. Rodriguez ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Neuropsychological Battery ◽  
One Year ◽  
Deep Brain Stimulation Surgery ◽  
Deep Brain

Fatigue is a common and disabling nonmotor symptom seen in Parkinson’s disease (PD). While deep brain stimulation surgery (DBS) improves motor symptoms, it has also been associated with non-motor side effects. To date no study has utilized standardized instruments to evaluate fatigue following DBS surgery. Our objective was to determine the prevalence of fatigue following DBS surgery in PD its impact on quality of life and explore predictive factors. We recruited 44 PD subjects. At least one year following DBS placement, we administered the Fatigue Severity Scale (FSS), the Parkinson’s Disease Questionnaire (PDQ-39), the Beck Depression Inventory, the Beck Anxiety Inventory, the UPDRS, and a neuropsychological battery. Fifty-eight percent of subjects had moderate to severe fatigue. Fatigue was significantly associated with quality of life, depression, and anxiety. Depression preoperatively was the only predictive factor of fatigue. Fatigue is common following DBS surgery and significantly impacts quality of life.

Clinical Motor Outcome of Bilateral Subthalamic Nucleus Deep-Brain Stimulation for Parkinson's Disease Using Image-Guided Frameless Stereotaxy

Neurosurgery ◽  
2010 ◽  
Vol 67 (4) ◽  
pp. 1088-1093 ◽  
Author(s):  
Helen Brontë-Stewart ◽  
Stephanie Louie ◽  
Sara Batya ◽  
Jaimie M Henderson
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Deep Brain Stimulation ◽  
Subthalamic Nucleus ◽  
Brain Stimulation ◽  
Neurosurgical Procedures ◽  
Image Guided ◽  
Delayed Hemorrhage ◽  
Stn Dbs ◽  
Deep Brain

Abstract BACKGROUND: Image-guided neuronavigation has largely replaced stereotactic frames when precise, real-time anatomic localization is required during neurosurgical procedures. However, some procedures, including placement of deep-brain stimulation (DBS) leads for the treatment of movement disorders, are still performed using frame-based stereotaxy. Despite the demonstration of comparable accuracy between frame-based and “frameless” image-guided approaches, the clinical efficacy of frameless DBS placement has never been reported. OBJECTIVE: To analyze the outcomes of subthalamic nucleus (STN) DBS using the frameless technique for the treatment of Parkinson's disease (PD). METHODS: Of 31 subjects (20 men) with PD for 10 ± 4 years, 28 had bilateral STN DBS and 3 had unilateral STN DBS. The Unified Parkinson's Disease Rating Scale (UPDRS) motor scale (III) and total medication doses were assessed before surgery on and off medication and off medication/ON DBS (off/ON) after 6 to 12 months of STN DBS. RESULTS: There was a 58% improvement from bilateral STN DBS in the UPDRS III (40 ± 16 preoperatively off, 17 ± 11 off/ON) 9.6 ± 1.9 months after surgery (P < .001). This compared favorably with the published outcomes using the frame-based technique. All motor subscores improved significantly (P < .01). The mean reduction in medication was 50%. No intraoperative complications occurred, but one subject with hypertension died of a delayed hemorrhage postoperatively. Two subjects developed postoperative infections that required lead removal and antibiotics. CONCLUSIONS: Bilateral STN DBS for PD performed by an experienced team using a frameless approach results in outcomes comparable to those reported with the use of the frame-based technique.

Postoperative delirium in Parkinson’s disease patients following deep brain stimulation surgery

2014 ◽  
Vol 21 (7) ◽  
pp. 1192-1195 ◽  
Author(s):  
Jonathan D. Carlson ◽  
Joshua J. Neumiller ◽  
Lindy D.W. Swain ◽  
Jamie Mark ◽  
Pam McLeod ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Postoperative Delirium ◽  
Deep Brain Stimulation Surgery ◽  
Deep Brain
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