gms | German Medical Science

63rd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Japanese Neurosurgical Society (JNS)

German Society of Neurosurgery (DGNC)

13 - 16 June 2012, Leipzig

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Use of microrecording and multiple trajectories in deep brain stimulation (DBS) of the nucleus subthalamicus

Meeting Abstract

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  • D. Falk - Klinik für Neurochirurgie, Universitätsklinikum Schleswig-Holstein, Campus Kiel
  • J.W. Lemos dos Reis - Klinik für Neurochirurgie, Universitätsklinikum Schleswig-Holstein, Campus Kiel
  • S. Paschen - Klinik für Neurologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel
  • N. Warneke - Klinik für Neurologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel
  • M. Mahvash - Klinik für Neurochirurgie, Universitätsklinikum Schleswig-Holstein, Campus Kiel
  • H.M. Mehdorn - Klinik für Neurochirurgie, Universitätsklinikum Schleswig-Holstein, Campus Kiel

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 63. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie (JNS). Leipzig, 13.-16.06.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. DocDO.04.04

doi: 10.3205/12dgnc049, urn:nbn:de:0183-12dgnc0494

Published: June 4, 2012

© 2012 Falk et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Objective: The need for intraoperative microrecording (MER) and the simultaneous use of multiple trajectories during DBS surgeries for the placement of electrodes in the subthalamic nucleus (STN) in Parkinson’s disesase is a point of ongoing discussion. In our department we used the microrecording in all cases. The aim of this study was to review our progress in respect to the possible benefit for the patients.

Methods: We retrospectively analysed all data of patients, who have undergone DBS-surgery for Parkinson's disease in our department in 2008 and 2009. We recorded the number of microelectrodes, the trajectory of the permanent electrode, the reasons for avoiding the central trajectory, the coordinates of the active contacts of the permanent electrode and the clinical outcome.

Results: In the 2-year-period, we performed bilateral stimulation of the STN in 80 patients with Parkinson's disease (160 procedures). We were able to use all 5 microelectrodes in 39,4%, and 3 or more in over 98,1%. For the permanent electrode, the central trajectory was chosen in 44,4%, which means that we implanted 55,6% over peripheral trajectories. The main reason was a better effect with sometimes just slight differences. The second reason was the border for side effects, which forced us to avoid the central trajectory. Due to the microrecording we were able to identify the borders of the STN in all cases and thereby the longest and best-responding trajectory, which could then be used for a shortened stimulation period. This helped the procedure, but the decision was always made on the basis of the intraoperative stimulation. The clinical results lie within the range of published data.

Conclusions: In our patient group we would have not reached the optimal target with a single trajectory guided by MRI in 55,6%. The microrecording is an additional tool for targeting, but the decision for the placement was made based on the test stimulation. Test stimulation is shortened since it is usually only performed in the trajectory with the best recording results. In our opinion, the simultaneous use of multiple trajectories is a reasonable tool for the optimal outcome of the patient.