Abstract
Objective: The aim of this study is to evaluate the evolution of GPi DBS targeting.Methods: This retrospective, single-center study included patients implanted with GPi DBS leads for dystonia or PD during the years 2004 to 2018 at the University of Florida Fixel Institute for Neurological Diseases. Each patient underwent a high-resolution targeting study on the day prior to the surgery, which was fused with a high resolution CT scan that was acquired on the day of the procedure. Intraoperative target location was selected using a digitized 3D Schaltenbrand-Bailey atlas. All patients underwent a high-resolution head CT scan without contrast approximately one month after lead implantation and accurate measurement of neuroanatomical lead position was acquired after fusion of pre-operative and post-operative image studies.Results: We analyzed 253 PD patients with 352 leads and 80 dystonia patients with 141 leads. During 15 years of follow-up, lead locations in the PD group migrated more laterally (β = 0.09, p < 0.0001), posteriorly [slope (β) = 0.04, p < 0.05], and dorsally (β = 0.07, p < 0.001), whereas leads in the dystonia group did not significantly change position aside from a trend in the dorsal direction (β = 0.06, p = 0.053).Conclusion: The evolving target likely results from multiple factors including improvements in targeting techniques and clinical feedback intraoperatively and post-operatively. Our demonstrates the potential importance of a systematic post-operative DBS lead measurement protocol to ensure quality control and to inform and optimize DBS programming.
Highlights
Deep brain stimulation (DBS) is a surgical therapy that uses a neurostimulator and one or multiple brain leads to modulate specific neural circuits [1]
The aim of this study is to evaluate the evolution of globus pallidus internus (GPi) DBS targeting over time through analysis of a large, single-center cohort
This is an IRB-approved, retrospective, single-center study including patients implanted with GPi DBS leads for dystonia or Parkinson’s disease (PD) during the years 2004–2018 at the University of Florida Fixel Institute for Neurological Diseases
Summary
Deep brain stimulation (DBS) is a surgical therapy that uses a neurostimulator and one or multiple brain leads to modulate specific neural circuits [1]. Modulation of the globus pallidus internus (GPi) is a well-established and highly effective therapeutic option for appropriately selected patients with Parkinson’s disease (PD) and for patients with severe dystonia that is refractory to optimized. The antiparkinsonian effects of GPi DBS are well recognized, there remains debate about the underlying therapeutic mechanism [5] and the ideal position for lead implantation within the target. Despite established efficacy and safety, the clinical response to DBS may at times be variable among patients and dependent on a variety of factors including patient selection, appropriate target selection, and adequate surgical planning. Half of the patients had sub optimally placed DBS electrodes, and 17% had leads that were not programmable. Several factors may influence lead placement, appropriate surgical planning is critical to the process
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