Experience with Microelectrode Guided Subthalamic Nucleus Deep Brain Stimulation

Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Neurosurgery (Impact Factor: 3.62). 03/2006; 58(1 Suppl):ONS96-102; discussion ONS96-102. DOI: 10.1227/01.NEU.0000192690.45680.C2
Source: PubMed


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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    • "This has resulted in a clear reduction in operation time. Similar rates have been reported by others with atlas-based (Amirnovin et al., 2006) and MRI-based targeting coordinates (Reck et al., 2012). The change from 1.5 to 3.0 T has also improved the accuracy of targeting (Toda et al., 2009; Kerl et al., 2012). "

    Full-text · Article · Aug 2015 · Frontiers in Integrative Neuroscience
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    • "In addition to the standard T2 MRI-based targeting, some centers are using intraoperative recordings with microelectrodes (MER) to identify STN activity. Through the interpretation of local neuronal spiking activity measured with MER, electrode placement is guided and it allows the neurosurgeon to functionally refine targeting (Amirnovin et al., 2006; Bour et al., 2010; Schlaier et al., 2013). "
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    ABSTRACT: In deep brain stimulation of the subthalamic nucleus (STN-DBS) for Parkinson's Disease (PD), often microelectrode recordings (MER) are used for STN identification. However, for advanced target identification of the sensorimotor STN, it may be relevant to use local field potential (LFP) recordings. Then, it is important to assure that the measured oscillations are coming from the close proximity of the electrode. Through multiple simultaneous recordings of LFP and neuronal spiking, we investigated the temporal relationship between local neuronal spiking and more global LFP. We analyzed the local oscillations in the LFP by calculating power only over specific frequencies that show a significant coherence between LFP and neuronal spiking. Using this 'coherence method', we investigated how well measurements in the sensorimotor STN could be discriminated from measurements elsewhere in the STN. The 'sensorimotor power index' (SMPI) of beta frequencies, representing the ability to discriminate sensorimotor STN measurements based on the beta power, was significantly larger using the 'coherence method' for LFP spectral analysis compared to other methods where either the complete LFP beta spectrum or only the prominent peaks in the LFP beta spectrum were used to calculate beta power. The results suggest that due to volume conduction of beta frequency oscillations, proper localization of the sensorimotor STN with only LFP recordings is difficult. However, combining recordings of LFP and neuronal spiking and calculating beta power over the coherent parts of the LFP spectrum can be beneficial in discriminating the sensorimotor STN. Copyright © 2015. Published by Elsevier B.V.
    Full-text · Article · Jun 2015 · Journal of Neuroscience Methods
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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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