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Sequential Brain Shift Patterns During Staged Bilateral Deep Brain Stimulation Surgery for Parkinson's Disease.

Junhyung Kim1, Sungyang Jo2, Sun Ju Chung2

  • 1Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul , Republic of Korea.

Operative Neurosurgery (Hagerstown, Md.)
|June 24, 2025
PubMed
Summary

Brain shift during deep brain stimulation (DBS) surgery for Parkinson's disease is significant, especially in the globus pallidus internus. A staged surgical approach helps minimize targeting errors by allowing for adjustments between procedures.

Keywords:
Brain shiftDeep brain stimulationFrame-based stereotaxyGlobus pallidus internusSubthalamic nucleus

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Area of Science:

  • Neurosurgery
  • Medical Imaging
  • Neurology

Background:

  • Brain shift, a displacement of brain structures, causes targeting inaccuracies in stereotactic neurosurgery.
  • Deep brain stimulation (DBS) is a key treatment for Parkinson's disease, but brain shift can complicate bilateral procedures.

Purpose of the Study:

  • To investigate sequential brain shift patterns during staged bilateral DBS surgery for Parkinson's disease.
  • To assess the clinical implications of brain shift for targeting accuracy in GPi and STN.
  • To evaluate the efficacy of a staged bilateral targeting strategy in mitigating brain shift.

Main Methods:

  • Quantitative image analysis of 210 DBS procedures in 105 Parkinson's disease patients.
  • Brain shift was measured by coordinate displacements of GPi and STN across four MRI sessions during staged bilateral DBS.
  • Shift was evaluated in three configurations: post-first DBS, pre-second vs. post-second DBS, and pre-first vs. post-second DBS.

Main Results:

  • Brain shift predominantly occurred in posterior, inferior, and medial directions, with greater magnitude in the GPi than STN.
  • Clinically relevant brain shift (>3 mm) was observed in 6.8% of GPi after the first DBS and up to 20.3% of GPi and 4.1% of STN after the second DBS.
  • Brain shift within the second procedure, relative to rescanned MRI, was reduced (4.1% GPi, 0% STN), supporting staged targeting. Pneumocephalus and low arterial pressure correlated with increased brain shift.

Conclusions:

  • Brain shift is a critical factor in bilateral DBS surgery for Parkinson's disease.
  • Staged bilateral DBS procedures offer advantages for precise targeting, particularly for the GPi.
  • This strategy aids in minimizing targeting errors and improving surgical outcomes.