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Bilateral deep brain stimulation of the subthalamic nucleus: Targeting differences between the first and second side
Filipa de Oliveira1, Rui Vaz1, Clara Chamadoira1
1Department of Neurosurgery, Centro Hospitalar e Universitário de São João, Porto, Portugal; Department of Clinical Neurosciences, Faculty of Medicine, University of Porto, Portugal; Movement Disorders and Functional Neurosurgery Unit, Centro Hospitalar e Universitário de São João, Porto, Portugal.
This study found that the second deep brain stimulation (DBS) electrode for Parkinson's disease (PD) targeting the subthalamic nucleus (STN) showed greater deviation than the first. Adjusting surgical plans for the second side may improve accuracy.
Area of Science:
- Neurosurgery
- Neurology
- Medical Devices
Background:
- Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is a key treatment for Parkinson's disease (PD).
- Accurate electrode placement is crucial for therapeutic success in STN-DBS.
- Variations in targeting accuracy between the first and second implanted electrodes are not well understood.
Purpose of the Study:
- To compare the accuracy of the first and second electrode placements in STN-DBS for Parkinson's disease.
- To analyze differences in electrode trajectories, microelectrode recording (MER) data, and positional deviations between bilateral STN-DBS procedures.
Main Methods:
- Retrospective analysis of 30 patients undergoing one-stage bilateral STN-DBS.
- Utilized three microelectrode arrays for STN localization and intraoperative stimulation for final target confirmation.
- Calculated Euclidean vector deviation between planned and final electrode positions using post-operative CT scans.
Main Results:
- The central channel was favored for the first electrode (70%) compared to the second (40%).
- Microelectrode recordings showed longer high-quality STN activity in the central channel on the first side.
- The second electrodes exhibited statistically significant deviations in anterior and inferior directions compared to the first side.
Conclusions:
- The second implanted STN-DBS electrode demonstrated a significant anterior and inferior deviation, suggesting factors beyond brain shift influence placement.
- Surgical planning for the second electrode should consider potential anterior trajectory adjustments.
- Optimizing planning for the second side may reduce the need for multiple MER trajectories and shorten surgery duration.
