Electrode Penetration of the Caudate Nucleus in Deep Brain Stimulation Surgery for Parkinson’s Disease

Abstract

<b><i>Objective:</i></b> To evaluate the possible influence of electrode trajectories penetrating the caudate nucleus (CN) on cognitive outcomes in deep brain stimulation (DBS) surgery for Parkinson’s disease (PD). <b><i>Background:</i></b> It is currently unclear how mandatory CN avoidance during trajectory planning is. <b><i>Design/Methods:</i></b> Electrode trajectories were determined to be inside, outside, or in border region of the CN. Pre- and postoperative neuropsychological tests of each trajectory group were compared in order to evaluate possible differences in cognitive outcomes 12 months after bilateral STN DBS. <b><i>Results:</i></b> One hundred six electrode tracks in 53 patients were evaluated. Bilateral penetration of the CN occurred in 15 (28%) patients, while unilateral penetration occurred in 28 (53%). In 19 (36%) patients tracks were located in the border region of the CN. There was no electrode penetration of the CN in 10 (19%) patients. No difference in cognitive outcomes was found between the different groups. <b><i>Conclusion:</i></b> Cognitive outcome was not influenced by DBS electrode tracks penetrating the CN. It is both feasible and sensible to avoid electrode tracks through the CN when possible, considering its function and anatomical position. However, penetration of the CN can be considered without major concerns regarding cognitive decline when this facilitates optimal trajectory planning due to specific individual anatomical variations.

Decline of verbal fluency with lateral superior frontal gyrus penetration in subthalamic nucleus deep brain stimulation for Parkinson disease

“…Similarly, several studies found caudate nucleus penetration effects on VF decline. 5,13,36 In our study, 48% and 50% of right-and left-sided electrodes, respectively, penetrated the caudate nucleus. No association was found between caudate nucleus penetration and VF outcome in our study.…”

“…8 Furthermore, despite an implicated role for the caudate nucleus on cognitive processes, there are few and inconsistent data on the effects of caudate nucleus penetration on VF decline following STN stimulation in patients with PD. 8,[12][13][14][15][16] The present study aims to examine the effect of STN DBS electrode trajectory, particularly frontal lobe and caudate lesioning, on VF decline.…”

Factors influencing the reliability of intraoperative testing in deep brain stimulation for Parkinson’s disease

“…Another influencing factor, which was not investigated in the present study was the path of the trajectories of the electrodes through the brain. For example, Witt et al pointed out that if the electrodes traverse the caudate nucleus postoperative cognitive deficits might occur [ 38 ], even though the study results could not be replicated by Bot et al [ 7 ].…”