Abstract
BackgroundThe accuracy of deep brain stimulation (DBS) depends on precise electrode positioning, which has been pursued for ideal treatment outcomes. As a critical component of DBS, the fixation performance of lead anchoring devices has been widely studied. Possible reasons for lead shift were analyzed in the current study and we further provided effective solutions to reduce potential manual errors.MethodsSeventy-nine patients who received DBS implantations at the Ruijin Hospital from April to November 2017 were retrospectively reviewed. Intraoperative lead shifts were measured by C-arm fluoroscopy. Lead adjustment counts were recorded and compared among three lead fixation devices: Stimloc™ (Medtronic, Minneapolis, MN, USA), TouchLoc (SceneRay, Suzhou, China), and the traditional lead anchoring device.ResultsMean (± SD) distances of lead shifts were 0.29 ± 2.42 mm in Stimloc devices, 0.43 ± 0.55 mm in TouchLoc devices, and 1.52 ± 1.05 mm in traditional devices (p < 0.0001). Average numbers of adjustments in this series were 0.3 ± 0.5 in Stimloc devices, 0.3 ± 1.3 in TouchLoc devices, and 1.1 ± 1.0 in traditional devices (p = 0.0001). Pairwise comparisons among the three devices (TouchLoc vs. Stimloc: p = 0.273; TouchLoc vs. Traditional: p = 0.0001; Stimloc vs. traditional: p < 0.0001) suggested significant differences, which were mainly attributed to the traditional devices.ConclusionsThree lead anchoring devices have been compared for their performance in the accuracy of lead fixation, in which the newly designed lead fixation devices have presented its advantages to the traditional one. In addition to the application of the Stimloc and TouchLoc devices, verification by C-arm fluoroscopy should be performed to provide an intuitive view of the depth deviation of electrode position during DBS electrode implantation.
Highlights
The accuracy of deep brain stimulation (DBS) depends on precise electrode positioning, which has been pursued for ideal treatment outcomes
In the traditional device group, 6 patients received devices manufactured by Medtronic and the remaining received products manufactured by PINS Medical
The electrodes were implanted in several functional nuclei, including 8 electrodes in the subthalamic nucleus (STN) of 6 patients, 123 electrodes in the globus pallidus internal (GPi) of 66 patients, 10 electrodes in the ventral capsule/ventral striatum of 5 patients, 4 electrodes in the habenular nucleus of 2 patients, 4 electrodes in the posterior subthalamic area of 2 patients, and 4 electrodes in the ventralis intermedius nucleus of 2 patients
Summary
The accuracy of deep brain stimulation (DBS) depends on precise electrode positioning, which has been pursued for ideal treatment outcomes. The accuracy of electrode positioning has always been considered a critical element in this therapy for optimal treatment outcome, and avoiding stimulation-related side effects [2]. Few literatures have described differences in lead fixation performance among lead anchoring devices Such a comparison would facilitate surgical optimization and accuracy improvement in DBS rather than promoting better lead anchoring devices. Aside from providing an analysis of lead fixation performance among these three lead anchoring devices, we present a surgical technique for lead anchoring in an attempt to reduce artificial errors based on our abundant experiences with DBS surgeries in our center (>2000 dB leads implanted in the past decade)
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