The Role of Microelectrode Recording and Stereotactic Computed Tomography in Verifying Lead Placement During Awake MRI-Guided Subthalamic Nucleus Deep Brain Stimulation for Parkinson's Disease

R Saman Vinke; Ashok K Selvaraj; Martin Geerlings; Dejan Georgiev; Aleksander Sadikov; Pieter L Kubben; Jonne Doorduin; Peter Praamstra; Bastiaan R Bloem; Ronald H M A Bartels; Rianne A J Esselink

doi:10.3233/JPD-223149

The Role of Microelectrode Recording and Stereotactic Computed Tomography in Verifying Lead Placement During Awake MRI-Guided Subthalamic Nucleus Deep Brain Stimulation for Parkinson's Disease

R Saman Vinke^*, Ashok K Selvaraj, Martin Geerlings, Dejan Georgiev, Aleksander Sadikov, Pieter L Kubben, Jonne Doorduin, Peter Praamstra, Bastiaan R Bloem, Ronald H M A Bartels, Rianne A J Esselink

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

BACKGROUND: Bilateral deep brain stimulation of the subthalamic nucleus (STN-DBS) has become a cornerstone in the advanced treatment of Parkinson's disease (PD). Despite its well-established clinical benefit, there is a significant variation in the way surgery is performed. Most centers operate with the patient awake to allow for microelectrode recording (MER) and intraoperative clinical testing. However, technical advances in MR imaging and MRI-guided surgery raise the question whether MER and intraoperative clinical testing still have added value in DBS-surgery.

OBJECTIVE: To evaluate the added value of MER and intraoperative clinical testing to determine final lead position in awake MRI-guided and stereotactic CT-verified STN-DBS surgery for PD.

METHODS: 29 consecutive patients were analyzed retrospectively. Patients underwent awake bilateral STN-DBS with MER and intraoperative clinical testing. The role of MER and clinical testing in determining final lead position was evaluated. Furthermore, interobserver variability in determining the MRI-defined STN along the planned trajectory was investigated. Clinical improvement was evaluated at 12 months follow-up and adverse events were recorded.

RESULTS: 98% of final leads were placed in the central MER-track with an accuracy of 0.88±0.45 mm. Interobserver variability of the MRI-defined STN was 0.84±0.09. Compared to baseline, mean improvement in MDS-UPDRS-III, PDQ-39 and LEDD were 26.7±16.0 points (54%) (p < 0.001), 9.0±20.0 points (19%) (p = 0.025), and 794±434 mg/day (59%) (p < 0.001) respectively. There were 19 adverse events in 11 patients, one of which (lead malposition requiring immediate postoperative revision) was a serious adverse event.

CONCLUSION: MER and intraoperative clinical testing had no additional value in determining final lead position. These results changed our daily clinical practice to an asleep MRI-guided and stereotactic CT-verified approach.

Original language	English
Pages (from-to)	1269-1278
Number of pages	10
Journal	Journal of Parkinsons Disease
Volume	12
Issue number	4
Early online date	29 Mar 2022
DOIs	https://doi.org/10.3233/JPD-223149
Publication status	Published - 2022

Keywords

Deep brain stimulation
ELECTRODE
EXPERIENCE
FUNCTIONAL NEUROSURGERY
MRI-guided
Parkinson's disease
STN
SURGERY
microelectrode recording
subthalamic nucleus

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10.3233/JPD-223149Licence: Free access - publisher

Cite this

Vinke, R. S., Selvaraj, A. K., Geerlings, M., Georgiev, D., Sadikov, A., Kubben, P. L., Doorduin, J., Praamstra, P., Bloem, B. R., Bartels, R. H. M. A., & Esselink, R. A. J. (2022). The Role of Microelectrode Recording and Stereotactic Computed Tomography in Verifying Lead Placement During Awake MRI-Guided Subthalamic Nucleus Deep Brain Stimulation for Parkinson's Disease. Journal of Parkinsons Disease, 12(4), 1269-1278. https://doi.org/10.3233/JPD-223149

@article{0e7c16d9dbb2479da791d06cec72a66f,

title = "The Role of Microelectrode Recording and Stereotactic Computed Tomography in Verifying Lead Placement During Awake MRI-Guided Subthalamic Nucleus Deep Brain Stimulation for Parkinson's Disease",

abstract = "BACKGROUND: Bilateral deep brain stimulation of the subthalamic nucleus (STN-DBS) has become a cornerstone in the advanced treatment of Parkinson's disease (PD). Despite its well-established clinical benefit, there is a significant variation in the way surgery is performed. Most centers operate with the patient awake to allow for microelectrode recording (MER) and intraoperative clinical testing. However, technical advances in MR imaging and MRI-guided surgery raise the question whether MER and intraoperative clinical testing still have added value in DBS-surgery.OBJECTIVE: To evaluate the added value of MER and intraoperative clinical testing to determine final lead position in awake MRI-guided and stereotactic CT-verified STN-DBS surgery for PD.METHODS: 29 consecutive patients were analyzed retrospectively. Patients underwent awake bilateral STN-DBS with MER and intraoperative clinical testing. The role of MER and clinical testing in determining final lead position was evaluated. Furthermore, interobserver variability in determining the MRI-defined STN along the planned trajectory was investigated. Clinical improvement was evaluated at 12 months follow-up and adverse events were recorded.RESULTS: 98% of final leads were placed in the central MER-track with an accuracy of 0.88±0.45 mm. Interobserver variability of the MRI-defined STN was 0.84±0.09. Compared to baseline, mean improvement in MDS-UPDRS-III, PDQ-39 and LEDD were 26.7±16.0 points (54%) (p < 0.001), 9.0±20.0 points (19%) (p = 0.025), and 794±434 mg/day (59%) (p < 0.001) respectively. There were 19 adverse events in 11 patients, one of which (lead malposition requiring immediate postoperative revision) was a serious adverse event.CONCLUSION: MER and intraoperative clinical testing had no additional value in determining final lead position. These results changed our daily clinical practice to an asleep MRI-guided and stereotactic CT-verified approach.",

keywords = "Deep brain stimulation, ELECTRODE, EXPERIENCE, FUNCTIONAL NEUROSURGERY, MRI-guided, Parkinson's disease, STN, SURGERY, microelectrode recording, subthalamic nucleus",

author = "Vinke, {R Saman} and Selvaraj, {Ashok K} and Martin Geerlings and Dejan Georgiev and Aleksander Sadikov and Kubben, {Pieter L} and Jonne Doorduin and Peter Praamstra and Bloem, {Bastiaan R} and Bartels, {Ronald H M A} and Esselink, {Rianne A J}",

note = "Publisher Copyright: {\textcopyright} 2022 - The authors. Published by IOS Press.",

year = "2022",

doi = "10.3233/JPD-223149",

language = "English",

volume = "12",

pages = "1269--1278",

journal = "Journal of Parkinsons Disease",

issn = "1877-7171",

publisher = "IOS Press",

number = "4",

}

Vinke, RS, Selvaraj, AK, Geerlings, M, Georgiev, D, Sadikov, A, Kubben, PL, Doorduin, J, Praamstra, P, Bloem, BR, Bartels, RHMA & Esselink, RAJ 2022, 'The Role of Microelectrode Recording and Stereotactic Computed Tomography in Verifying Lead Placement During Awake MRI-Guided Subthalamic Nucleus Deep Brain Stimulation for Parkinson's Disease', Journal of Parkinsons Disease, vol. 12, no. 4, pp. 1269-1278. https://doi.org/10.3233/JPD-223149

The Role of Microelectrode Recording and Stereotactic Computed Tomography in Verifying Lead Placement During Awake MRI-Guided Subthalamic Nucleus Deep Brain Stimulation for Parkinson's Disease. / Vinke, R Saman; Selvaraj, Ashok K; Geerlings, Martin et al.
In: Journal of Parkinsons Disease, Vol. 12, No. 4, 2022, p. 1269-1278.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - The Role of Microelectrode Recording and Stereotactic Computed Tomography in Verifying Lead Placement During Awake MRI-Guided Subthalamic Nucleus Deep Brain Stimulation for Parkinson's Disease

AU - Vinke, R Saman

AU - Selvaraj, Ashok K

AU - Geerlings, Martin

AU - Georgiev, Dejan

AU - Sadikov, Aleksander

AU - Kubben, Pieter L

AU - Doorduin, Jonne

AU - Praamstra, Peter

AU - Bloem, Bastiaan R

AU - Bartels, Ronald H M A

AU - Esselink, Rianne A J

PY - 2022

Y1 - 2022

N2 - BACKGROUND: Bilateral deep brain stimulation of the subthalamic nucleus (STN-DBS) has become a cornerstone in the advanced treatment of Parkinson's disease (PD). Despite its well-established clinical benefit, there is a significant variation in the way surgery is performed. Most centers operate with the patient awake to allow for microelectrode recording (MER) and intraoperative clinical testing. However, technical advances in MR imaging and MRI-guided surgery raise the question whether MER and intraoperative clinical testing still have added value in DBS-surgery.OBJECTIVE: To evaluate the added value of MER and intraoperative clinical testing to determine final lead position in awake MRI-guided and stereotactic CT-verified STN-DBS surgery for PD.METHODS: 29 consecutive patients were analyzed retrospectively. Patients underwent awake bilateral STN-DBS with MER and intraoperative clinical testing. The role of MER and clinical testing in determining final lead position was evaluated. Furthermore, interobserver variability in determining the MRI-defined STN along the planned trajectory was investigated. Clinical improvement was evaluated at 12 months follow-up and adverse events were recorded.RESULTS: 98% of final leads were placed in the central MER-track with an accuracy of 0.88±0.45 mm. Interobserver variability of the MRI-defined STN was 0.84±0.09. Compared to baseline, mean improvement in MDS-UPDRS-III, PDQ-39 and LEDD were 26.7±16.0 points (54%) (p < 0.001), 9.0±20.0 points (19%) (p = 0.025), and 794±434 mg/day (59%) (p < 0.001) respectively. There were 19 adverse events in 11 patients, one of which (lead malposition requiring immediate postoperative revision) was a serious adverse event.CONCLUSION: MER and intraoperative clinical testing had no additional value in determining final lead position. These results changed our daily clinical practice to an asleep MRI-guided and stereotactic CT-verified approach.

AB - BACKGROUND: Bilateral deep brain stimulation of the subthalamic nucleus (STN-DBS) has become a cornerstone in the advanced treatment of Parkinson's disease (PD). Despite its well-established clinical benefit, there is a significant variation in the way surgery is performed. Most centers operate with the patient awake to allow for microelectrode recording (MER) and intraoperative clinical testing. However, technical advances in MR imaging and MRI-guided surgery raise the question whether MER and intraoperative clinical testing still have added value in DBS-surgery.OBJECTIVE: To evaluate the added value of MER and intraoperative clinical testing to determine final lead position in awake MRI-guided and stereotactic CT-verified STN-DBS surgery for PD.METHODS: 29 consecutive patients were analyzed retrospectively. Patients underwent awake bilateral STN-DBS with MER and intraoperative clinical testing. The role of MER and clinical testing in determining final lead position was evaluated. Furthermore, interobserver variability in determining the MRI-defined STN along the planned trajectory was investigated. Clinical improvement was evaluated at 12 months follow-up and adverse events were recorded.RESULTS: 98% of final leads were placed in the central MER-track with an accuracy of 0.88±0.45 mm. Interobserver variability of the MRI-defined STN was 0.84±0.09. Compared to baseline, mean improvement in MDS-UPDRS-III, PDQ-39 and LEDD were 26.7±16.0 points (54%) (p < 0.001), 9.0±20.0 points (19%) (p = 0.025), and 794±434 mg/day (59%) (p < 0.001) respectively. There were 19 adverse events in 11 patients, one of which (lead malposition requiring immediate postoperative revision) was a serious adverse event.CONCLUSION: MER and intraoperative clinical testing had no additional value in determining final lead position. These results changed our daily clinical practice to an asleep MRI-guided and stereotactic CT-verified approach.

KW - Deep brain stimulation

KW - ELECTRODE

KW - EXPERIENCE

KW - FUNCTIONAL NEUROSURGERY

KW - MRI-guided

KW - Parkinson's disease

KW - STN

KW - SURGERY

KW - microelectrode recording

KW - subthalamic nucleus

U2 - 10.3233/JPD-223149

DO - 10.3233/JPD-223149

M3 - Article

C2 - 35367970

SN - 1877-7171

VL - 12

SP - 1269

EP - 1278

JO - Journal of Parkinsons Disease

JF - Journal of Parkinsons Disease

IS - 4

ER -