An exploratory investigation of optimal cortical puncture site in ROSA-assisted operation of STN-DBS

Abstract

Objective To explore the optimal cortical puncture site in deep brain stimulation of subthalamic nucleus (STN-DBS). Methods Fifty patients of Parkinson’s disease (PD) were enrolled into this study who were consecutively admitted to Department of Neurosurgery, General Hospital of Shenyang Military Command from September 2016 to April 2017 and underwent bilateral STN-DBS (100 electrodes implanted) assisted by the ROSA (robotized stereotactic assistance) system. CT angiography and MRI fused images were used to avoid the blood vessels in plan of surgical trajectory. Data of microelectrode recording (MER) in 100 trajectories were documented, out of which 80 trajectories with MER≥5 mm were selected. Cartesian coordinate system was established in the 3D image of ROSA. The distances were measured which were from the cortical entry point to the median sagittal line and from the cortical entry point to projected line of coronal suture of the skull onto the cortex. Moreover, the reference range was calculated and the optimal cortical puncture site was decided. Results There was no case of cerebral hemorrhage in this series. For those electrode implantation with MER ≥5 mm, distances from the entry point to the median sagittal line were decided to be 50.8 mm (maximal), 29.6 mm (minimal) and 37.9±5.0 mm (average). The distances between the cortical entry point to projection of coronal suture were 30.3 mm (maximal), -8.5 mm (minimal) and 9.0±6.5 mm (average). Conclusion In STN-DBS, choosing cortical puncture site within the area (32.9-42.8 mm lateral to the midline and 2.5-15.5 mm anterior to the coronal suture) might have greater chance of achieving satisfactory electrophysiological recordings, which could also be useful in operations assisted by the traditional stereotactic frame. Key words: Deep brain stimulation; Subthalamic nucleus; Robotized stereotactic assistant; Cortical puncture point; Microelectrode recording