Procedural Variables Influencing Stereotactic Accuracy and Efficiency in Deep Brain Stimulation Surgery.
Adult
Aged
Aged, 80 and over
Deep Brain Stimulation
/ methods
Female
Globus Pallidus
/ surgery
Humans
Male
Microelectrodes
Middle Aged
Movement Disorders
/ surgery
Neurosurgical Procedures
/ methods
Retrospective Studies
Stereotaxic Techniques
Subthalamic Nucleus
/ surgery
Treatment Outcome
Young Adult
Accuracy
Deep brain stimulation
Microelectrode recording
Parkinson disease
Surgery time
Journal
Operative neurosurgery (Hagerstown, Md.)
ISSN: 2332-4260
Titre abrégé: Oper Neurosurg (Hagerstown)
Pays: United States
ID NLM: 101635417
Informations de publication
Date de publication:
01 07 2019
01 07 2019
Historique:
received:
09
01
2018
accepted:
24
08
2018
pubmed:
20
10
2018
medline:
24
9
2020
entrez:
20
10
2018
Statut:
ppublish
Résumé
Deep brain stimulation (DBS) is well-established, evidence-based therapy for Parkinson disease, essential tremor, and primary dystonia. Clinical outcome studies have recently shown that "asleep" DBS lead placement, performed using intraoperative imaging with stereotactic accuracy as the surgical endpoint, has motor outcomes comparable to traditional "awake" DBS using microelectrode recording (MER), but with shorter case times and improved speech fluency. To identify procedural variables in DBS surgery associated with improved surgical efficiency and stereotactic accuracy. Retrospective review of 323 cases with 546 leads placed (August 2011-October 2014). In 52% (n = 168) of cases, patients were asleep under general anesthesia without MER. Multivariate regression identified independent predictors of reduced surgery time and improved stereotactic accuracy. MER was an independent contributor to increased procedure time (+44 min; P = .03). Stereotactic accuracy was better in asleep patients. Accuracy was improved with frame-based stereotaxy at head of bed 0° vs frameless stereotaxy at head of bed 30°. Improved accuracy was also associated with shorter procedures (r = 0.17; P = .049). Vector errors were evenly distributed around the planned target for the globus pallidus internus, but directionally skewed for the subthalamic (medial-posterior) and ventral intermediate nuclei (medial-anterior). Distinct procedural variables in DBS surgery are associated with reduced case times and improved stereotactic accuracy.
Sections du résumé
BACKGROUND
Deep brain stimulation (DBS) is well-established, evidence-based therapy for Parkinson disease, essential tremor, and primary dystonia. Clinical outcome studies have recently shown that "asleep" DBS lead placement, performed using intraoperative imaging with stereotactic accuracy as the surgical endpoint, has motor outcomes comparable to traditional "awake" DBS using microelectrode recording (MER), but with shorter case times and improved speech fluency.
OBJECTIVE
To identify procedural variables in DBS surgery associated with improved surgical efficiency and stereotactic accuracy.
METHODS
Retrospective review of 323 cases with 546 leads placed (August 2011-October 2014). In 52% (n = 168) of cases, patients were asleep under general anesthesia without MER. Multivariate regression identified independent predictors of reduced surgery time and improved stereotactic accuracy.
RESULTS
MER was an independent contributor to increased procedure time (+44 min; P = .03). Stereotactic accuracy was better in asleep patients. Accuracy was improved with frame-based stereotaxy at head of bed 0° vs frameless stereotaxy at head of bed 30°. Improved accuracy was also associated with shorter procedures (r = 0.17; P = .049). Vector errors were evenly distributed around the planned target for the globus pallidus internus, but directionally skewed for the subthalamic (medial-posterior) and ventral intermediate nuclei (medial-anterior).
CONCLUSION
Distinct procedural variables in DBS surgery are associated with reduced case times and improved stereotactic accuracy.
Identifiants
pubmed: 30339204
pii: 5136509
doi: 10.1093/ons/opy291
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
70-78Informations de copyright
Copyright © 2018 by the Congress of Neurological Surgeons.