Article

Experience with Microelectrode Guided Subthalamic Nucleus Deep Brain Stimulation

Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Neurosurgery (Impact Factor: 3.03). 03/2006; 58(1 Suppl):ONS96-102; discussion ONS96-102. DOI: 10.1227/01.NEU.0000192690.45680.C2
Source: PubMed

ABSTRACT Subthalamic deep brain stimulation (DBS) has rapidly become the standard surgical therapy for medically refractory Parkinson disease. However, in spite of its wide acceptance, there is considerable variability in the technical approach. This study details our technique and experience in performing microelectrode recording (MER) guided subthalamic nucleus (STN) DBS in the treatment of Parkinson disease.
Forty patients underwent surgery for the implantation of 70 STN DBS electrodes. Stereotactic localization was performed using a combination of magnetic resonance and computed tomographic imaging. We used an array of three microelectrodes, separated by 2 mm, for physiological localization of the STN. The final location was selected based on MER and macrostimulation through the DBS electrode.
The trajectory selected for the DBS electrode had an average pass through the STN of 5.6 +/- 0.4 mm on the left and 5.7 +/- 0.4 mm on the right. The predicted location was used in 42% of the cases but was modified by MER in the remaining 58%. Patients were typically discharged on the second postoperative day. Eighty-five percent of patients were sent home, 13% required short-term rehabilitation, and one patient required long-term nursing services. Seven complications occurred over 4 years. Four patients suffered small hemorrhages, one patient experienced a lead migration, one developed an infection of the pulse generator, and one patient suffered from a superficial cranial infection.
Simultaneous bilateral MER-guided subthalamic DBS is a relatively safe and well-tolerated procedure. MER plays an important role in optimal localization of the DBS electrodes.

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    • "Microelectrode recordings are routinely performed prior to the implantation of deep brain stimulating electrodes to aid with localization (Amirnovin et al. 2006; Gross et al. 2006). Consideration for surgery was unrelated to the research protocol and was conducted by a multidisciplinary team of neurologists, neurosurgeons, a neuropsychologist , and a nurse practitioner. "
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    • "No sedatives were given during the surgery. The general techniques of stereotactic localization and intraoperative microelectrode recordings are described elsewhere (Hutchison et al., 1998; Amirnovin et al., 2004, 2006). We performed physiologic localization using an array of three tungsten microelectrodes (1 MOhm impedance; FHC Incorporated, Bowdoin, ME), separated by 2 mm, and placed in a parasagittal orientation. "
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    • "A local anesthetic was used prior to the incision and burr hole placement. The stereotactic localization using preoperative MRI and computerized tomography, as well as general techniques of intraoperative microelectrode recordings have been described previously [1], [4], [5]. Single-unit recordings were made from the dorsal-lateral motor subterritory of the STN based on stereotactic localization and reconstructions of the electrode trajectories [1]. "
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