Deep brain stimulation surgical techniques

Stereotactic techniques for placement of deep brain stimulation (DBS) electrodes have undergone continuous refinement since the introduction of human stereotaxis in the 1940s. Volumetric imaging techniques, including magnetic resonance imaging and computed tomography, have replaced ventriculography, and increasingly sophisticated computer systems now allow highly refined targeting of subcortical structures. This chapter reviews the underlying principles of stereotactic surgery, including imaging, targeting, and registration, and describes the surgical approach to DBS placement using both framed and frameless techniques.