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Psychosurgery, the surgical alteration or permanent removal of brain tissue to alleviate severe psychological conditions, stands as one of the most radical and controversial treatments in the history of mental health care. Its development and application have evolved significantly, marked by dramatic shifts in scientific understanding and ethical perspectives.
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In the 1930s, Portuguese neurologist Antonio Egas Moniz introduced a surgical procedure designed...

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Surgical Technique for Repositioning Deep Brain Stimulation Electrodes.

Robert Ziechmann1, Kevin Hines, Caio Matias

  • 1Department of Neurological Surgery, Thomas Jefferson University, Philadelphia , Pennsylvania , USA.

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|September 23, 2025
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Summary

Repositioning deep brain stimulation (DBS) electrodes with suboptimal accuracy is improved by using the initial error direction and magnitude. This systematic error is reproducible, aiding in surgical correction for better patient outcomes.

Keywords:
Deep brain stimulationElectrode repositioningStereotaxic techniquesSurgical technique

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Area of Science:

  • Neurosurgery
  • Robotic Surgery
  • Medical Imaging

Background:

  • Deep brain stimulation (DBS) electrode placement accuracy is crucial for surgical success.
  • A systematic approach for repositioning DBS electrodes with suboptimal first-pass accuracy, especially in asleep DBS surgery, is lacking in current literature.

Purpose of the Study:

  • To evaluate the reliability of using the direction and magnitude of initial radial error to guide repositioning of DBS electrodes.
  • To analyze the reproducibility of systematic errors in DBS electrode placement.

Main Methods:

  • Retrospective analysis of DBS procedures using an image-guided, image-verified robotic technique (July 2018 - November 2024).
  • Surgical repositioning technique based on the direction and magnitude of first-pass radial error, measured via intraoperative O-arm CT.
  • Analysis of 506 passes for 441 electrodes.

Main Results:

  • Final radial error after repositioning averaged 0.96 ± 0.38 mm, comparable to existing literature.
  • The direction of radial error was consistent between the first and second passes in 71.74% of revisions, indicating reproducibility.
  • The relationship between initial and subsequent radial error direction was statistically significant (P < .001).

Conclusions:

  • The direction and magnitude of initial radial error in DBS electrode placement can be reliably used for accurate correction.
  • Suboptimal electrode placement likely results from reproducible systematic errors influenced by procedural and patient-specific anatomical factors.