Abstract
Objective: Bilateral globus pallidus internus deep brain stimulation (GPi-DBS) is an established and effective therapy for primary refractory dystonia. However, the comparison of frameless vs. frame-based DBS surgery technique is still controversial. This retrospective study aims to compare the clinical outcome of two GPi-DBS surgical techniques for patients affected by primary generalized or multi-segmental dystonia.Methods: For lead's stereotaxic placement, 10 patients underwent frame-based surgery and the other 10 subjects DBS surgery with a frameless technique. Clinical features were evaluated at baseline and 6 and 12 months after surgery by means of the Burke–Fahn–Marsden Dystonia Rating Scale.Results: Frame-based GPi-DBS and frameless stereotaxic group revealed a comparable clinical outcome with no surgical complications.Conclusions: Frameless technique is safe and well-tolerated by patients and showed similar effectiveness of the frame-based stereotaxic surgery during GPi-DBS for primary dystonia. Notably, it could be a valid alternative solution because of the great advantage in improving the patient's discomfort during awake surgery.
Highlights
IntroductionDeep brain stimulation (DBS) is a well-established therapy for several movement disorders, and bilateral globus pallidus internus (GPi) stimulation is used as an effective and relatively safe treatment for different forms of medically refractory dystonia
This study aims to evaluate the clinical outcome of globus pallidus internus (GPi)-Deep brain stimulation (DBS) in a homogeneous population of dystonic patients who underwent GPi-DBS surgery using a frameless technique or a frame-based stereotaxy
Two neurosurgeons were involved in OR, and each of them had a great experience in DBS frame-based stereotaxy since 2000 and, for frameless technique, more than 6 years at the time of collecting data
Summary
Deep brain stimulation (DBS) is a well-established therapy for several movement disorders, and bilateral globus pallidus internus (GPi) stimulation is used as an effective and relatively safe treatment for different forms of medically refractory dystonia. One of the most important key issues for successful DBS surgery is the lead’s placement into the target nucleus: an incorrect positioning may result in ineffective symptom control and adverse effects related to electrical stimulation. Lead’ misplacement has been considered as one of Frameless GPi-DBS in Dystonia the major reasons for patient’s discomfort or even DBS failure [13,14,15]. To improve the lead’s placement, detailed imaging techniques and intraoperative microelectrode recording (MER) are performed to identify the right target localization during surgery [16]. DBS surgery is performed using frame-based stereotaxy, but, in recent years, frameless techniques are available
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