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Updated: Sep 25, 2025
Intra-Operative Behavioral Tasks in Awake Humans Undergoing Deep Brain Stimulation Surgery
Published on: January 6, 2011
Awake Deep Brain Stimulation Surgery Without Intraoperative Imaging Is Accurate and Effective: A Case Series
Johnie O Hodge1, Piper Cook, Nicholas J Brandmeir
1Department of Neurosurgery, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia, USA.
Background:
The success of deep brain stimulation (DBS) surgery depends on the accuracy of electrode placement. Several factors can affect this such as brain shift, the quality of preoperative planning, and technical factors. It is crucial to determine whether techniques yield accurate lead placement and effective symptom relief. Many of the studies establishing the accuracy of frameless techniques used intraoperative imaging to further refine lead placement.
Objective:
To determine whether awake lead placement without intraoperative imaging can achieve similar minimal targeting error while preserving clinical results.
Methods:
Eighty-two trajectories in 47 patients who underwent awake, frameless DBS lead placement with the Fred Haer Corporation STarFix system for essential tremor or Parkinson's disease were analyzed. Neurological testing during lead placement was used to determine appropriate lead locations, and no intraoperative imaging was performed. Accuracy data were compared with previously performed studies.
Results:
The Euclidean error for the patient cohort was 1.79 ± 1.02 mm, and the Pythagorean error was 1.40 ± 0.95 mm. The percentage symptom improvement evaluated by the Unified Parkinson's Disease Rating Scale for Parkinson's disease or the Fahn-Tolosa-Marin scale for essential tremor was similar to reported values at 58% ± 17.2% and 67.4% ± 24.7%, respectively. The operative time was 95.0 ± 30.3 minutes for all study patients.
Conclusion:
Awake, frameless DBS surgery with the Fred Haer Corporation STarFix system does not require intraoperative imaging for stereotactic accuracy or clinical effectiveness.
