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Updated: Jul 4, 2025
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Intra-Operative Behavioral Tasks in Awake Humans Undergoing Deep Brain Stimulation Surgery
Published on: January 6, 2011
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Improved Side-Effect Stimulation Thresholds and Postoperative Transient Confusion With Asleep, Image-Guided Deep
Rohit Kesarwani1,2,3, Uma V Mahajan1, Alexander S Wang1,4
1Case Western Reserve University School of Medicine, Cleveland , Ohio , USA.
Operative Neurosurgery (Hagerstown, Md.)
|February 2, 2024
Summary
Image-guided deep brain stimulation (DBS) shows comparable efficacy to microelectrode recording (MER) guidance but with higher stimulation thresholds for side effects. Image-guided DBS also significantly reduces the risk of postoperative transient confusion (pTC).
Area of Science:
- Neurosurgery
- Neurology
- Medical Imaging
Background:
- Deep brain stimulation (DBS) is a crucial therapy for movement disorders.
- Traditional microelectrode recording (MER) guidance for DBS is performed while the patient is awake.
- Asleep, image-guided DBS, utilizing intraoperative 3D-fluoroscopy (i3D-F), offers a modern alternative.
Purpose of the Study:
- To compare the clinical efficacy of MER-guided DBS versus i3D-F-guided DBS.
- To evaluate differences in stimulation thresholds for side effects between the two guidance techniques.
- To assess and compare the incidence of postoperative transient confusion (pTC) following DBS procedures using either guidance method.
Main Methods:
- A retrospective analysis of consecutive patients undergoing DBS from 2006 to 2021.
- Patients were categorized based on whether they received MER-guided or i3D-F-guided DBS.
- Outcomes assessed included changes in Unified Parkinson's Disease Rating Scale (UPDRS)-III, levodopa equivalent daily dose, Fahn-Tolosa-Marin scores, stimulation thresholds, and complication rates, including pTC.
Main Results:
- No significant differences in clinical efficacy scores (UPDRS-III, daily dose, Fahn-Tolosa-Marin) were observed between MER-guided and i3D-F-guided DBS.
- Higher stimulation thresholds for side effects were noted with i3D-F guidance in the subthalamic nucleus (3.46 mA vs. 2.80 mA) and ventrointermediate thalamus (3.19 mA vs. 2.81 mA).
- The rate of postoperative transient confusion (pTC) was significantly lower with i3D-F guidance (1.2%) compared to MER guidance (7.5%).
Conclusions:
- Clinical efficacy of MER-guided and i3D-F-guided DBS is comparable for Parkinson's disease and essential tremor.
- Intraoperative 3D-fluoroscopy (i3D-F) guidance may lead to higher stimulation thresholds for side effects.
- Image-guided DBS, specifically i3D-F, demonstrates a reduced risk of postoperative transient confusion (pTC).
