Deep brain stimulation (DBS) of the hypothalamic nucleus (STN) is a globally recognized neuromodulation method for the treatment of Parkinson's disease (PD)
.
To date, there are several methods of electrode implantation, including preoperative imaging guidance, intraoperative test-assisted microelectrode recording (MER), and methods for intraoperative computed tomography (CT) or magnetic resonance imaging (MRI) validation
.
In previous studies, MER was considered an effective approach to target the STN region in DBS surgery
.
As image-guided DBS surgery has experienced significant growth in recent decades, it has been suggested that MER is not a necessary approach for STN-DBS
.
Image-guided localization also raised the possibility of DBS during sleep
.
Given the level of stress and discomfort, patients with peritonitis prefer to perform surgery while sleeping rather than awake
.
However, intraoperative CT or MRI facilities for confirming electrode placement are not widely available, especially in developing countries
.
Therefore, it is crucial to obtain an estimated success rate of STN localization only by preoperative MRI
.
The accuracy of targeting was strongly related to the outcome of STN-DBS in improving symptoms
.
Different implantation methods at different medical centers reported varying degrees of targeting accuracy
.
Several factors are known to play a role in targeting accuracy, such as the stereotaxic system used, the target site, and brain metastases due to cerebrospinal fluid loss and intracranial air
.
Here, we propose that MER can serve as a predictor of targeting accuracy during STN-DBS
.
Hereby, Zhe Zhenga et al.
, of the Second Affiliated Hospital of Zhejiang University, retrospectively analyzed single-center data from patients who received awake STN-DBS to explore implantation success rates based on preoperative imaging alone, and those obtained by surgery alone.
Targeting accuracy of ex-imaging versus MER-guided surgery
.
They performed a retrospective analysis of 161 Parkinson's disease patients who underwent STN-DBS at our center from March 2013 to June 2021
.
Implantation was performed by direct magnetic resonance imaging (MRI)-based localization preoperatively, with intraoperative MER and macrostimulation testing
.
285 electrode trajectories including preoperative and postoperative coordinates were included to calculate placement error for STN targeting
.
Under preoperative MRI guidance, 85.
9% of electrodes were implanted without intraoperative adjustments
.
Thirty-one (10.
2%) and 12 (3.
9%) electrodes underwent intraoperative adjustments for MER and intraoperative testing, respectively
.
They found that 86.
2% (245/285) of electrodes had track errors ≤2 mm
.
In the MER physiological signal length <4 mm and ≥4 mm groups, 38.
0% and 8.
8% of electrodes had track errors >2 mm, respectively
.
The final positioning of the MER-adjusted electrodes is offset from the center of the STN compared to the unadjusted electrodes
.
.
The significance of this study lies in its findings: As a result of preoperative MRI-guided STN localization, electrodes need to be repositioned in approximately 14% of cases
.
The length of the MER physiological signal was <4 mm at the first penetration, implying a deviation from the planned target
.
MER combined with intraoperative sobriety testing can help rescue this MRI-only deviation
.
.
Original source:
Zheng Z, Zhu Z, Ying Y, et al.
The Accuracy of Imaging Guided Targeting with Microelectrode Recoding in Subthalamic Nucleus for Parkinson's Disease: A Single-Center Experience.
The Accuracy of Imaging Guided Targeting with Microelectrode Recoding in Subthalamic Nucleus for Parkinson's Disease: A Single-Center Experience.
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