Abstract
Object: Deep brain stimulation (DBS) is a very useful procedure for the treatment of idiopathic Parkinson’s disease (PD), essential tremor, and dystonia. The authors evaluated the accuracy of the new method used in their center for the placing of DBS electrodes. Electrodes are placed using the intraoperative O-arm™ (Medtronic)-controlled frameless and fiducial-less system, Nexframe™ (Medtronic). Accuracy was evaluated prospectively in eleven consecutive PD patients (22 electrodes). Methods: Eleven adult patients with PD were implanted using the Nexframe system without fiducials and with the intraoperative O-arm (Medtronic) system and StealthStation™ S8 navigation (Medtronic). The implantation of DBS leads was performed using multiple-cell microelectrode recording, and intraoperative test stimulation to determine thresholds for stimulation-induced adverse effects. The accuracy was checked in three different steps: (1) using the intraoperative O-arm image and its fusion with preoperative planning, (2) using multiple-cell microelectrode recording and counting the number of microelectrodes with the signal of the subthalamic nucleus (STN) and finally, (3) total error was calculated according to a postoperative CT control image fused to preoperative planning. Results: The total error of the procedure was 1.79 mm; the radial error and the vector error were 171 mm and 163 mm. Conclusions: Implantation of DBS electrodes using an O-arm navigated frameless and fiducial-less system is a very useful and technically feasible procedure with excellent patient toleration with experienced Nexframe users. The accuracy of the method was confirmed at all three steps, and it is comparable to other published results.
Highlights
Deep brain stimulation (DBS) is an established technique for modulation of subcortical brain structures in patients with Parkinson’s disease [1,2], essential tremor [3], dystonia [4,5], and other selected movement disorders
We recorded the signal from the subthalamic nucleus (STN) in all patients, which confirmed a good position of the microelectrodes within the STN
Channels that showed significant multi-unit activity over a length longer than 3 mm were selected for intraoperative test stimulation (60 μs pulse duration; 130 Hz pulse frequency, 1–4 mA for Parkinson’s disease (PD))
Summary
Deep brain stimulation (DBS) is an established technique for modulation of subcortical brain structures in patients with Parkinson’s disease [1,2], essential tremor [3], dystonia [4,5], and other selected movement disorders. Class I evidence supports its use in Parkinson’s disease, in comparison with the best medical treatment [6]. There is a growing tendency to indicate DBS for earlier stages of Parkinson’s disease [7,8]. DBS electrodes have conventionally been placed using frame-based stereotaxis with microelectrode recording (MER) and physiological mapping of target structures. An alternative using a frameless neuronavigation-guided implantation technique with skull-mounted aiming devices (NexframeTM, STarFixTM, ClearpointTM) together with bone-implanted fiducial markers is used in some workplaces. A new method using the Nexframe system without fiducials coupled
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