Abstract
Background and purpose: Target point identification based solely on MRI and CT of subthalamic nucleus (STN) in deep brain stimulation procedures (DBS) for Parkinson’s disease (PD) might have suboptimal clinical effects. The authors analyse alterations of permanent electrode location depending on neurophysiological evaluation compared to an anatomically based calculated target. Materials and methods: The group comprised 66 patients (32 females and 34 males) aged 57.6 (38–76) years, in whom 131 electrodes were implanted. The patients were qualified for the surgery according to the CAPSIT-PD criteria. STN was identified using the direct and indirect methods, based on 1.5 T MRI and CT. The surgery was performed under local anesthesia. Two to 5 microelectrodes were used for microrecording and macrostimulation. Results: Anterior (49.2%), central (35.6%) and lateral (13.6%) trajectories were most frequently used for permanent electrode placement. The electrode was most frequently placed at a depth of +2/+3 (58.3%) or +1 and +5 mm (36.4%) with regard to the planned target point. Differences in selecting the trajectory and depth of the final electrode position were statistically significant (p<0.05). Conclusion: DBS implantation based only on anatomical identification of STN can lead to suboptimal results. Additional application of intrasurgical neurophysiological analysis may increase the effectiveness of the STN DBS therapy for PD.
Highlights
Parkinson’s disease (PD) is a cause of disability in 1.5% of the population aged over 60 years of age and is an important socioeconomic problem
deep brain stimulation procedures (DBS) implantation based only on anatomical identification of subthalamic nucleus (STN) can lead to suboptimal results
Additional application of intrasurgical neurophysiological analysis may increase the effectiveness of the STN DBS therapy for PD
Summary
Parkinson’s disease (PD) is a cause of disability in 1.5% of the population aged over 60 years of age and is an important socioeconomic problem. Symptomatic treatment of PD consists mainly of pharmacological supplementation and modulation of the dopaminergic system. In 4–10% of patients with PD, insufficient pharmacological treatment may force a neurosurgical treatment trial. Neurosurgical ablative treatment (pallidotomy, thalamotomy) of PD was introduced in the 1940s and was effective in selected patients. Target point identification based solely on MRI and CT of subthalamic nucleus (STN) in deep brain stimulation procedures (DBS) for Parkinson’s disease (PD) might have suboptimal clinical effects. The authors analyse alterations of permanent electrode location depending on neurophysiological evaluation compared to an anatomically based calculated target
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