719 Deep Brain Stimulation for Movement Disorders: Lead Placement without Microelectrode Recording

Abstract BACKGROUND Microelectrode recording (MER) can be used to map out the target nucleus and identify ideal lead placement. OBJECTIVE To assess the use of multichannel MER to increase the efficiency of lead placement without compromising patient safety. METHODS Analysis of a single center's technique for utilizing multichannel MER with 3 consistent anterior-to-posterior simultaneous passes that include an evaluation of the location of final lead placement, patient diagnosis, target nuclei, and additional work involved for refinement of targeting. Lead revision rates and rate of hemorrhage are also assessed. RESULTS There were a total of 237 lead placements in 123 patients over a 4-yr period. In 4.2% of lead placements, additional planning was required, while only 2.5% required additional MER. The lead placement matched 51.3% of the time in bilateral placements and was consistent regardless of target nuclei. In 84.8% of cases, the final lead placement was within the initial 3 MER passes. An additional 11.3% could be placed without the need for an additional pass. There were 2 lead revisions and no hemorrhage or stroke complications. CONCLUSION This series demonstrates that our technique of multichannel MER leads to accurate and efficient lead placement maintaining its safety profile.

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Neurophysiological biomarkers to optimize deep brain stimulation in movement disorders

Neurodegenerative Disease Management ◽

10.2217/nmt-2021-0002 ◽

2021 ◽

Author(s):

Daniel Sirica ◽

Angela L Hewitt ◽

Christopher G Tarolli ◽

Miriam T Weber ◽

Carol Zimmerman ◽

...

Keyword(s):

Deep Brain Stimulation ◽

Local Field ◽

Brain Stimulation ◽

Movement Disorders ◽

High Frequency ◽

Field Potentials ◽

Beta Band ◽

Pathological Characteristics ◽

Lead Placement ◽

Deep Brain

Intraoperative neurophysiological information could increase accuracy of surgical deep brain stimulation (DBS) lead placement. Subsequently, DBS therapy could be optimized by specifically targeting pathological activity. In Parkinson’s disease, local field potentials (LFPs) excessively synchronized in the beta band (13–35 Hz) correlate with akinetic-rigid symptoms and their response to DBS therapy, particularly low beta band suppression (13–20 Hz) and high frequency gamma facilitation (35–250 Hz). In dystonia, LFPs abnormally synchronize in the theta/alpha (4–13 Hz), beta and gamma (60–90 Hz) bands. Phasic dystonic symptoms and their response to DBS correlate with changes in theta/alpha synchronization. In essential tremor, LFPs excessively synchronize in the theta/alpha and beta bands. Adaptive DBS systems will individualize pathological characteristics of neurophysiological signals to automatically deliver therapeutic DBS pulses of specific spatial and temporal parameters.

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Microelectrode Recording-Guided Deep Brain Stimulation in Patients with Movement Disorders (First Trial in Korea)

Basal Ganglia and Thalamus in Health and Movement Disorders ◽

10.1007/978-1-4615-1235-6_31 ◽

2001 ◽

pp. 341-347 ◽

Cited By ~ 5

Author(s):

Jin Woo Chang ◽

Bae Hwan Lee ◽

Myung Sik Lee ◽

Jong Hee Chang ◽

Yong Gou Park ◽

...

Keyword(s):

Deep Brain Stimulation ◽

Brain Stimulation ◽

Movement Disorders ◽

Microelectrode Recording ◽

Deep Brain

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Two Hundred Twenty-Six Consecutive Deep Brain Stimulation Electrodes Placed Using an “Asleep” Technique and the Neuro|MateTM Robot for the Treatment of Movement Disorders

Operative Neurosurgery ◽

10.1093/ons/opaa176 ◽

2020 ◽

Vol 19 (5) ◽

pp. 530-538

Author(s):

Catherine Moran ◽

Nagaraja Sarangmat ◽

Carter S Gerard ◽

Neil Barua ◽

Reiko Ashida ◽

...

Keyword(s):

Deep Brain Stimulation ◽

Brain Stimulation ◽

Movement Disorders ◽

Zona Incerta ◽

Angular Error ◽

Electrode Placement ◽

Radial Error ◽

Lead Placement ◽

The Mean ◽

Deep Brain

Abstract BACKGROUND Robotics in neurosurgery has demonstrated widening indications and rapid growth in recent years. Robotic precision and reproducibility are especially pertinent to the field of functional neurosurgery. Deep brain stimulation (DBS) requires accurate placement of electrodes in order to maximize efficacy and minimize side effects. In addition, asleep techniques demand clear target visualization and immediate on-table verification of accuracy. OBJECTIVE To describe the surgical technique of asleep DBS surgery using the Neuro|MateTM Robot (Renishaw plc, Wotton-under-Edge, United Kingdom) and examine the accuracy of DBS lead placement in the subthalamic nucleus (STN) for the treatment of movement disorders. METHODS A single-center retrospective review of 113 patients who underwent bilateral STN/Zona Incerta electrode placement was performed. Accuracy of implantation was assessed using 5 measurements, Euclidian distance, radial error, depth error, angular error, and shift error. RESULTS A total of 226 planned vs actual electrode placements were analyzed. The mean 3-dimensional vector error calculated for 226 trajectories was 0.78 +/− 0.37 mm. The mean radial displacement off planned trajectory was 0.6 +/− 0.33 mm. The mean depth error, angular error, and shift error was 0.4 +/− 0.35 mm, 0.4 degrees, and 0.3 mm, respectively. CONCLUSION This report details our institution's method for DBS lead placement in patients under general anaesthesia using anatomical targeting without microelectrode recordings or intraoperative test stimulation for the treatment of movement disorders. This is the largest reported dataset of accuracy results in DBS surgery performed asleep. This novel robot-assisted operative technique results in sub-millimeter accuracy in DBS electrode placement.

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The Effect of Deep Brain Stimulation for Movement Disorders on Emotions

PsycEXTRA Dataset ◽

10.1037/e626972012-165 ◽

2008 ◽

Author(s):

Jonathan D. Richards ◽

Paul M. Wilson ◽

Pennie S. Seibert ◽

Carin M. Patterson ◽

Caitlin C. Otto ◽

...

Keyword(s):

Deep Brain Stimulation ◽

Brain Stimulation ◽

Movement Disorders ◽

Deep Brain

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Reoperation for device infection and erosion following deep brain stimulation implantable pulse generator placement

Journal of Neurosurgery ◽

10.3171/2019.3.jns183023 ◽

2020 ◽

Vol 133 (2) ◽

pp. 403-410 ◽

Cited By ~ 1

Author(s):

Travis J. Atchley ◽

Nicholas M. B. Laskay ◽

Brandon A. Sherrod ◽

A. K. M. Fazlur Rahman ◽

Harrison C. Walker ◽

...

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Deep Brain Stimulation ◽

Brain Stimulation ◽

Movement Disorders ◽

Pulse Generator ◽

Rank Test ◽

Implantable Pulse Generator ◽

Device Infection ◽

Deep Brain

OBJECTIVEInfection and erosion following implantable pulse generator (IPG) placement are associated with morbidity and cost for patients with deep brain stimulation (DBS) systems. Here, the authors provide a detailed characterization of infection and erosion events in a large cohort that underwent DBS surgery for movement disorders.METHODSThe authors retrospectively reviewed consecutive IPG placements and replacements in patients who had undergone DBS surgery for movement disorders at the University of Alabama at Birmingham between 2013 and 2016. IPG procedures occurring before 2013 in these patients were also captured. Descriptive statistics, survival analyses, and logistic regression were performed using generalized linear mixed effects models to examine risk factors for the primary outcomes of interest: infection within 1 year or erosion within 2 years of IPG placement.RESULTSIn the study period, 384 patients underwent a total of 995 IPG procedures (46.4% were initial placements) and had a median follow-up of 2.9 years. Reoperation for infection occurred after 27 procedures (2.7%) in 21 patients (5.5%). No difference in the infection rate was observed for initial placement versus replacement (p = 0.838). Reoperation for erosion occurred after 16 procedures (1.6%) in 15 patients (3.9%). Median time to reoperation for infection and erosion was 51 days (IQR 24–129 days) and 149 days (IQR 112–285 days), respectively. Four patients with infection (19.0%) developed a second infection requiring a same-side reoperation, two of whom developed a third infection. Intraoperative vancomycin powder was used in 158 cases (15.9%) and did not decrease the infection risk (infected: 3.2% with vancomycin vs 2.6% without, p = 0.922, log-rank test). On logistic regression, a previous infection increased the risk for infection (OR 35.0, 95% CI 7.9–156.2, p < 0.0001) and a lower patient BMI was a risk factor for erosion (BMI ≤ 24 kg/m2: OR 3.1, 95% CI 1.1–8.6, p = 0.03).CONCLUSIONSIPG-related infection and erosion following DBS surgery are uncommon but clinically significant events. Their respective timelines and risk factors suggest different etiologies and thus different potential corrective procedures.

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