Procedural Variables Influencing Stereotactic Accuracy and Efficiency in Deep Brain Stimulation Surgery

Area of Science:

• Neurosurgery
• Neurology
• Medical Technology

Background:

• Deep brain stimulation (DBS) is an established therapy for Parkinson disease, essential tremor, and dystonia.
• Recent studies indicate "asleep" DBS lead placement offers comparable motor outcomes to traditional "awake" DBS with microelectrode recording (MER).
• "Asleep" DBS may reduce procedure times and improve speech fluency compared to awake procedures.

Purpose of the Study:

• Identify procedural variables in DBS surgery linked to enhanced surgical efficiency.
• Determine factors associated with improved stereotactic accuracy in DBS procedures.

Main Methods:

• Retrospective analysis of 323 DBS cases involving 546 lead placements (August 2011-October 2014).
• Comparison of "asleep" DBS (general anesthesia, no MER) versus "awake" DBS (with MER).
• Multivariate regression analysis to identify predictors of surgery duration and stereotactic accuracy.

Main Results:

• Microelectrode recording (MER) significantly increased procedure time (+44 min; P = .03).
• Stereotactic accuracy was superior in "asleep" DBS procedures.
• Frame-based stereotaxy at 0° head elevation improved accuracy compared to frameless stereotaxy at 30°.
• Shorter procedures correlated with improved accuracy (r = 0.17; P = .049).
• Directional skew in vector errors observed for subthalamic and ventral intermediate nuclei targets.

Conclusions:

• Specific procedural variables in DBS surgery are demonstrably linked to reduced operative times.
• These variables also contribute to enhanced stereotactic accuracy during DBS lead placement.
• "Asleep" DBS techniques show promise for improving surgical efficiency and precision.