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Microelectrode Recording During Deep Brain Stimulation Does Not Consistently Represent Lead Trajectory.

Kevin Hines1, Isha Sharan1, Joseph Schaefer1

  • 1Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia , Pennsylvania , USA.

Operative Neurosurgery (Hagerstown, Md.)
|June 18, 2024
PubMed
Summary

Accurate deep brain stimulation (DBS) lead placement is crucial. Microelectrode recording (MER) assistance did not significantly improve DBS lead accuracy, with many leads deviating from MER trajectories. Intraoperative imaging is recommended for DBS lead placement confirmation.

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Area of Science:

  • Neurosurgery
  • Medical Device Technology
  • Neurological Surgery

Background:

  • Deep brain stimulation (DBS) long-term outcomes rely on precise lead placement.
  • Microelectrode recording (MER) is traditionally used to guide DBS electrode trajectories using neurophysiological data.
  • The consistency of electrode placement relative to MER trajectories requires evaluation.

Purpose of the Study:

  • To assess the accuracy and consistency of DBS lead placement guided by MER.
  • To compare the final DBS lead position with the microelectrode recording probe trajectory.
  • To evaluate the deviation of DBS leads from MER trajectories.

Main Methods:

  • Retrospective analysis of 29 DBS leads in 15 patients undergoing subthalamic nucleus targeting.
  • Intraoperative computed tomography (iCT) used to measure radial deviation between MER probe and final DBS lead position.
  • Comparison of lead placement accuracy with and without MER assistance, including preoperative target to final lead error.

Main Results:

  • No significant difference in mean radial target error between DBS leads placed with (1.2 mm) or without (1.0 mm) MER assistance.
  • Mean deviation between MER probe and final DBS lead position was 0.9 mm.
  • 44.8% of MER-assisted electrodes deviated 1.0 mm or more radially from the MER probe trajectory.

Conclusions:

  • DBS electrode placement can significantly deviate from MER trajectories.
  • Neurophysiological data from MER may not accurately represent the final electrode position.
  • Intraoperative imaging or other adjunctive methods are recommended to confirm DBS lead accuracy and trajectory.