Does the use of intraoperative microelectrode recording (MER) influence the final location of lead implant in deep brain stimulation (DBS) in Parkinson's disease patients?
Context: The use of Microelectrode recording in deep brain stimulation is a debated topic, as some authors believe it improves the precision of implants location, while others say it increases complications and offers no additional benefits. Objective: To determine if the use of intraoperative microelectrode recording (MER) influences the final location of lead implant in Parkinson’s disease (PD) patients undergoing deep brain stimulation (DBS) and to assess the incidence of associated complications. Methods: We conducted a retrospective chart review of all PD patients who underwent DBS with MER at the University of Texas Health Science Center in Houston from June 1st 2009 to October 1st 2013. A total of 88 lead implants on 45 patients were reviewed, 62 leads in sub-thalamic nucleus (STN) and 26 in globus pallidus interna (GPi). Initial coordinates as determined with a pre-operative MRI and final coordinates of implant after intraoperative MER were compared. To assess hemorrhagic and infectious complications, post-operative CT scan of the head and outpatient follow-up notes for a period of 1 year from the date of surgery were reviewed. Results: A statistically significant difference between the initial and final coordinates was observed only in the superior-inferior plane in both STN (p<0.05) and GPi (p<0.05) implants, with a respective mean difference of 0.29 mm and 0.63 mm inferiorly. One patient (2.2%) had subdural blood layering and 6 (13.3%) had minimal intra-ventricular bleeding on post-operative CT, of which only 1 (2.2%) had transient seizures. None of them had hypertension or intra-parenchymal hemorrhage. None of the patients required a revision for lack of benefits or uncontrollable side effects. Conclusions: Intra-operative MER significantly modifies final lead placement with an acceptable rate of surgical complications.
Reddy, Sujan, "Does the use of intraoperative microelectrode recording (MER) influence the final location of lead implant in deep brain stimulation (DBS) in Parkinson's disease patients?" (2015). Texas Medical Center Dissertations (via ProQuest). AAI1603943.