A technique for minimally altering anatomically based subthalamic electrode targeting by microelectrode recording

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Object

Implantation of a subthalamic nucleus (STN) deep brain stimulation (DBS) electrode is increasingly recognized as an effective treatment for advanced Parkinson disease (PD). Despite widespread use of microelectrode recording (MER) to delineate the boundaries of the STN prior to stimulator implantation, it remains unclear to what extent MER improves the clinical efficacy of this procedure. In this report, the authors analyze a series of patients who were treated at one surgical center to determine to what degree final electrode placement was altered, based on readings obtained with MER, from the calculated anatomical target.

Methods

Subthalamic DBS devices were placed bilaterally in nine patients with advanced PD. Frame-based volumetric magnetic resonance images were acquired and then transferred to a stereotactic workstation to determine the anterior and posterior commissure coordinates and plane. The initial anatomical target was 4 mm anterior, 4 mm deep, and 12 mm lateral to the midcommissural point. The MERs defined the STN boundaries along one or more parallel tracks, refining the final electrode placement by comparison of results with illustrations in a stereotactic atlas.

In eight of 18 electrodes, the MER results did not prompt an alteration in the anatomically derived target. In another eight placements, MER altered the target by less than 1 mm and two of 18 electrode positions differed by less than 2 mm. The anterior–posterior difference was 0.53 ± 0.65 mm, whereas the medial–lateral direction differed by 0.25 ± 0.43 mm. The ventral boundary of the STN defined by MER was 2 ± 0.72 mm below the calculated target (all values are the means ± standard deviation). All patients attained clinical improvement, similar to previous reports.

Conclusions

In this series of patients, microelectrode mapping of the STN altered the anatomically based target only slightly. Because it is not clear whether such minor adjustments improve clinical efficacy, a prospective clinical comparison of MER-refined and anatomical targeting may be warranted.

Abbreviations used in this paper:AC–PC = anterior commissure–posterior commissure; AP = anterior–posterior; DBS = deep brain stimulation; MER = microelectrode recording; ML = medial–lateral; MR = magnetic resonance; PD = Parkinson disease; STN = subthalamic nucleus.

Object

Implantation of a subthalamic nucleus (STN) deep brain stimulation (DBS) electrode is increasingly recognized as an effective treatment for advanced Parkinson disease (PD). Despite widespread use of microelectrode recording (MER) to delineate the boundaries of the STN prior to stimulator implantation, it remains unclear to what extent MER improves the clinical efficacy of this procedure. In this report, the authors analyze a series of patients who were treated at one surgical center to determine to what degree final electrode placement was altered, based on readings obtained with MER, from the calculated anatomical target.

Methods

Subthalamic DBS devices were placed bilaterally in nine patients with advanced PD. Frame-based volumetric magnetic resonance images were acquired and then transferred to a stereotactic workstation to determine the anterior and posterior commissure coordinates and plane. The initial anatomical target was 4 mm anterior, 4 mm deep, and 12 mm lateral to the midcommissural point. The MERs defined the STN boundaries along one or more parallel tracks, refining the final electrode placement by comparison of results with illustrations in a stereotactic atlas.

In eight of 18 electrodes, the MER results did not prompt an alteration in the anatomically derived target. In another eight placements, MER altered the target by less than 1 mm and two of 18 electrode positions differed by less than 2 mm. The anterior–posterior difference was 0.53 ± 0.65 mm, whereas the medial–lateral direction differed by 0.25 ± 0.43 mm. The ventral boundary of the STN defined by MER was 2 ± 0.72 mm below the calculated target (all values are the means ± standard deviation). All patients attained clinical improvement, similar to previous reports.

Conclusions

In this series of patients, microelectrode mapping of the STN altered the anatomically based target only slightly. Because it is not clear whether such minor adjustments improve clinical efficacy, a prospective clinical comparison of MER-refined and anatomical targeting may be warranted.

Abbreviations used in this paper:AC–PC = anterior commissure–posterior commissure; AP = anterior–posterior; DBS = deep brain stimulation; MER = microelectrode recording; ML = medial–lateral; MR = magnetic resonance; PD = Parkinson disease; STN = subthalamic nucleus.

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Contributor Notes

Address reprint requests to: Robert R. Goodman, M.D., Ph.D., Neurological Institute of New York, Department of Neurological Surgery, 710 West 168th Street, Box 99, New York, New York 10032. email: rrg2@columbia.edu.
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