Microelectrode targeting of the subthalamic nucleus for deep brain stimulation surgery

Area of Science:

• Neurosurgery
• Neurology
• Medical Engineering

Background:

• Deep brain stimulation (DBS) accuracy is crucial for patient outcomes.
• Microelectrode recording (MER) may enhance DBS targeting but increases risks and costs.
• Controlled clinical studies on MER effectiveness are limited.

Purpose of the Study:

• To calculate the spatial variability of physiologically defined optimal targets for subthalamic nucleus (STN) DBS using MER.
• To assess the effectiveness of a MER algorithm based on the number of penetrations required.

Main Methods:

• Analysis of 108 patient cases to determine the spatial variability of optimal STN targets identified by MER.
• Calculation of the 99% confidence radius for including the optimal target.
• Comparison of the MER-defined target volume with the estimated radius of DBS effect.

Main Results:

• The 99% confidence radius for the optimal target volume was 4.5 mm, larger than the estimated DBS effect (2-3.9 mm).
• In 70% of cases, imaging-based trajectories aligned with the optimal target; 70% of the remaining 30% required one additional MER tract.
• The MER algorithm demonstrated robustness in identifying the optimal target.

Conclusions:

• The spatial extent of MER-guided targeting may necessitate broader surveying to ensure coverage of the optimal target.
• While MER is effective, interpretation of data requires careful consideration of its limitations and the effective stimulation radius.