gms | German Medical Science

58. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

26. bis 29.04.2007, Leipzig

Is there a need for mikroelectrode recording for deep brain stimulation of the subthalamic nucleus? A neurologist's point of view

Brauchen wir Mikroelektrodenableitungen für die tiefe Hirnstimulation im Nucleus Subthalamicus? Eine neurologische Betrachtung

Meeting Abstract

  • corresponding author M. Lange - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Regensburg
  • J. Schlaier - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Regensburg
  • A. Janzen - Klinik und Poliklinik für Neurologie, Universitätsklinikum Regensburg
  • J. Winkler - Klinik und Poliklinik für Neurologie, Universitätsklinikum Regensburg
  • T. Finkenzeller - Institut für Röntgendiagnostik, Universität Regensburg
  • A. Brawanski - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Regensburg

Deutsche Gesellschaft für Neurochirurgie. 58. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC). Leipzig, 26.-29.04.2007. Düsseldorf: German Medical Science GMS Publishing House; 2007. DocP 023

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgnc2007/07dgnc278.shtml

Veröffentlicht: 11. April 2007

© 2007 Lange et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

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Objective: More than 30.000 Deep Brain Stimulation (DBS) implantations have been performed worldwide, approximately about 3.000 in Germany. However, there is no standardized surgical procedure. Although different sets of microelectrodes are available, some DBS-centers do not rely on microelectrode recording (MER). There is a controverse debate whether (1) the use of microelectrode recording increases the patient’s risk for intra- and postinterventional complications or (2) has an impact on an improved clinical outcome.

Methods: Retrospectively, 20 patients with idiopathic Parkinson's disease who underwent bilateral DBS of the Subthalamic Nucleus (STN) using MER during surgery were analysed. Regularly 2 to 5 microelectrodes were used per hemisphere based on direct targeting. Recording was initiated every 0,5 mm starting 10 mm rostral to the calculated target and ending 1 - 2 mm caudal to the calculated target point. Subsequently, teststimulation was performed via the macro-tip of the recording microelectrode by stepwise increasing the stimulation intensity. Therefore, the most anterior-dorso-lateral trajectory within the STN was chosen first to determine the effect/side-effect threshold. Based on the clinical evaluation during testing stimulation was performed in 1 to 4 trajectories. Finally, the DBS-electrode was implanted in the trajectory with the best effect- / side-effect ratio.

Results: Of the 40 DBS-electrodes 18 (45 %) were implanted in the central, 9 (22,5%) in the anterior, 6 (15%) in the medial, 5 (12,5%) in the posterior and 2 (5%) in the lateral trajectory. In total, 179 microelectrodes were used. Based on microelectrode recording, 132 (74%) were located within the STN. Furthermore, 70 (39%) microelectrodes were used for teststimulation to determine the trajectory with the best clinical outcome.

Conclusions: Despite the methodological limitations of the present study our results support the clinical notion to use microelectrode recording prior to macroelectrode implantation. Our findings are in agreement with a previous study that less than 50% of macroelectrodes are identical to the central trajectory (Amirnovin et al., 2006). To test the hypothesis whether multiple trajectories may lead to a better clinical outcome a randomized, multicenter based study is urgently warranted.