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J Neurol Surg A Cent Eur Neurosurg 2021; 82(01): 018-026
DOI: 10.1055/s-0040-1716329
Original Article

Intraoperative Neurophysiologic Assessment in Deep Brain Stimulation Surgery and its Impact on Lead Placement

Philipp Krauss
1   Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, Germany
,
Markus Florian Oertel
2   Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
,
Heide Baumann-Vogel
3   Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
,
Lukas Imbach
3   Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
,
Christian Rainer Baumann
3   Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
,
Johannes Sarnthein
2   Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
,
Luca Regli
2   Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
,
Lennart Henning Stieglitz
2   Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Abstract

Objectives While the efficacy of deep brain stimulation (DBS) to treat various neurological disorders is undisputed, the surgical methods differ widely and the importance of intraoperative microelectrode recording (MER) or macrostimulation (MS) remains controversially debated. The objective of this study is to evaluate the impact of MER and MS on intraoperative lead placement.

Patients and Methods We included 101 patients who underwent awake bilateral implantation of electrodes in the subthalamic nucleus with MER and MS for Parkinson's disease from 2009 to 2017 in a retrospective observational study. We analyzed intraoperative motor outcomes between anatomically planned stimulation point (PSP) and definite stimulation point (DSP), lead adjustments and Unified Parkinson's Disease Rating Scale Item III (UPDRS-III), levodopa equivalent daily dose (LEDD), and adverse events (AE) after 6 months.

Results We adjusted 65/202 leads in 47/101 patients. In adjusted leads, MS results improved significantly when comparing PSP and DSP (p < 0.001), resulting in a number needed to treat of 9.6. After DBS, UPDRS-III and LEDD improved significantly after 6 months in adjusted and nonadjusted patients (p < 0.001). In 87% of leads, the active contact at 6 months still covered the optimal stimulation point during surgery. In total, 15 AE occurred.

Conclusion MER and MS have a relevant impact on the intraoperative decision of final lead placement and prevent from a substantial rate of poor stimulation outcome. The optimal stimulation points during surgery and chronic stimulation strongly overlap. Follow-up UPDRS-III results, LEDD reductions, and DBS-related AE correspond well to previously published data.

Keywords

DBS - deep brain stimulation - intraoperative neurophysiology - neuromodulation - Parkinson's disease

Ethical Approval

All procedures performed in this study were in accordance with the ethical standards of the regional research committee (Kantonale Ethikkomission Zürich) and the Declaration of Helsinki (1964) and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.




Publication History

Received: 12 October 2019

Accepted: 13 February 2020

Article published online:
13 October 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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