Article
Implantation of directional deep brain stimulation electrodes under general anesthesia in Parkinson’s disease patients – How much lead deviation from the optimal position can be revised?
Implantation direktionaler DBS-Elektroden in Narkose bei Parkinson-Patienten – Wie groß darf die Abweichung von der optimalen Position sein?
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Authors
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Vesna Malinova
- Georg-August-Universität Göttingen, Neurochirurgie, Göttingen, Deutschland
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Ntenis Nerntengian
- Georg-August-Universität Göttingen, Neurochirurgie, Göttingen, Deutschland
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Christina Dragaescu
- Paracelsus-Elena-Klinik Kassel, Neurologie, Kassel, Deutschland
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Friederike Sixel-Döring
- Paracelsus-Elena-Klinik Kassel, Neurologie, Kassel, Deutschland
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Claudia Trenkwalder
- Georg-August-Universität Göttingen, Neurochirurgie, Göttingen, Deutschland; Paracelsus-Elena-Klinik Kassel, Neurologie, Kassel, Deutschland
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Veit Rohde
- Georg-August-Universität Göttingen, Neurochirurgie, Göttingen, Deutschland
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Dorothee Mielke
- Georg-August-Universität Göttingen, Neurochirurgie, Göttingen, Deutschland
| Published: | June 26, 2020 |
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Outline
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Objective: Deep brain stimulation (DBS) is an established treatment option in patients with Parkinson’s Disease (PD). Directional DBS (dDBS) represents one of the recent advances in DBS-surgery. Since its introduction, the number of DBS-surgeries under general anesthesia is rising, which might bear a higher risk for suboptimal lead position compared to awake surgery. We evaluated the correlation of lead position with the postoperative stimulation effect in PD-patients with implanted dDBS-system under general anesthesia.
Methods: We performed a retrospective analysis of patients with dDBS-system (Vercise, Boston Scientific) implantation under general anesthesia at our department between 2017 and 2019. The lead position in relation to the subthalamic nucleus (STN) was evaluated after fusion of the postoperative CT dataset with the preoperative MRI dataset and after anatomical mapping and autosegmentation of the STN by means of the stereotactic planning software Elements Brainlab. The lead position was classified as optimal (dorsolateral part of STN), marginal lateral, marginal medial, marginal anterior and marginal posterior or outside of the STN, respectively. The stimulation effect was calculated as the ratio of motor UPDRS-III pre- and postoperatively.
Results: A total of 29 patients with 58 implanted leads were included. The mean age was 68.8 (range 43-71) years. The lead positions were as followed: optimal in 29.3% (17/58), marginal lateral in 19.1% (11/58), marginal medial in 34.5% (20/58), marginal dorsal in 1.7% (1/58) and none of the leads had a marginal anterior position. A position outside of the STN was detected in 15.5% (9/58) with a mean distance to the STN of 1.5 mm (range 0.6 -3.6 mm). The mean UPDRS-III ratio was 2.5 (range 0.9-4,6). In patients with an optimal lead position, the UPDRS-III ratio was 3.1 compared to 2.7 in patients with a lead position outside of the STN, which was not statistically significant. In one patient with a marginal medial lead position no satisfactory stimulation was achieved.
Conclusion: dDBS seem to compensate a suboptimal lead position in most of the cases. Even in cases with a lead position outside of the STN, no significant differences in stimulation effects compared to the cases with an optimal lead position. Nevertheless, in exceptional cases a suboptimal lead position might result in an unsatisfactory stimulation, which should be avoided by increasing the accuracy of lead positioning.
