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Related Experiment Video

Updated: Jan 18, 2026

Intra-Operative Behavioral Tasks in Awake Humans Undergoing Deep Brain Stimulation Surgery
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Lead-Shift Error and Pneumocephalus in Awake, Robotic Deep Brain Stimulation Patients.

Sibi Rajendran1,2, Lokeshwar S Bhenderu1,2,3, Jesus G Cruz-Garza1,2

  • 1Department of Neurological Surgery, Houston Methodist Hospital, Houston , Texas , USA.

Operative Neurosurgery (Hagerstown, Md.)
|June 3, 2025
PubMed
Summary
This summary is machine-generated.

In awake robotic-assisted deep brain stimulation (DBS), right-sided lead placement showed increased error, but pneumocephalus volume did not correlate with lead misplacement. Further research is needed to optimize DBS therapeutic benefits.

Keywords:
DBSFunctional neurosurgeryLead errorPneumocephalusRoboticStereotactic

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Area of Science:

  • Neurosurgery
  • Neurology
  • Medical Imaging

Background:

  • Deep brain stimulation (DBS) lead placement accuracy is crucial for treatment efficacy, with errors >2 mm impacting outcomes.
  • Mechanisms of lead displacement and brain shift during DBS are not fully understood.
  • Variability in anesthesia and surgical techniques complicates error attribution.

Purpose of the Study:

  • To investigate the relationship between pneumocephalus and lead shift error in awake, robotic-assisted DBS surgery.
  • To compare lead placement accuracy between left and right sides in bilateral DBS procedures.

Main Methods:

  • Seventy-six patients undergoing awake, robotic-assisted DBS for VIM or STN targets were included.
  • Bilateral lead placement was performed sequentially (left then right).
  • Stereotactic CT scans immediately post-operation were used to compare planned targets with actual lead positions and measure pneumocephalus volume.

Main Results:

  • All patients exhibited some degree of pneumocephalus (average 18.9 ± 15.8 cm³).
  • Right-sided leads demonstrated significantly greater placement error (medial shift) compared to left-sided leads for both STN and VIM targets (P < .01).
  • No significant correlation was found between the total pneumocephalus volume and the magnitude of lead misplacement.

Conclusions:

  • Awake robotic-assisted DBS procedures can experience lead placement errors, particularly on the right side.
  • Pneumocephalus, while consistently present, did not directly correlate with the degree of lead misplacement in this study.
  • Addressing systematic errors and understanding pneumocephalus's role are key to optimizing DBS outcomes.