Final Electrode Position in Subthalamic Nucleus Deep Brain Stimulation Surgery: A Comparison of Indirect and Direct Targeting Methods.

Abstract

High frequency stimulation of the subthalamic nucleus (STN) is nowadays a widely performed surgery for patients with Parkinson's disease (PD). The field has witnessed a shift from indirect targeting to direct targeting. The question arises whether this change has influenced the final electrode position in STN deep brain stimulation surgery. To address this question, we compared the final electrode positions in atlas-based and magnetic resonance-based targeting methods in our series. We performed a database review of the surgeries performed in three affiliated centers. We have found that with the shift to direct imaging, three key changes have taken place. The first is that the number of microelectrode recording trajectories has decreased by approximately 1 microelectrode. Secondly, the central trajectory has been chosen as the final position in more patients, and the third change is that direct targeting has improved the laterality of the targeting significantly. Direct targeting has changed routine clinical practice, thereby further refining the surgical approach.