Implantation of deep brain stimulators into subthalmic nucleus: technical approach and magnetic imaging—verified electrode locations

Abstract

The authors' approach to implantation of DBS leads into the STN was associated with consistent lead placement in the dorsolateral STN, a low rate of morbidity, efficient use of operating room time, and robust improvement in motor function. The mean coordinates of the middle of the electrode array, measured on postoperative MR images, were 11.6 mm lateral, 2.9 mm posterior, and 4.7 mm inferior to the midcommissural point, and 6.5 mm lateral and 3.5 mm anterior to the center of the red nucleus. Voltage thresholds for several types of stimulation-induced adverse effects were predictive of lead location. Technical nuances of the surgery are described in detail.

Frame-based stereotaxy in a frameless era: current capabilities, relative role, and the positive- and negative predictive values of blood through the needle

“…We feel that this is a more realistic estimate of the sort of accuracy one can expect in a given procedure. This corresponds well with in vivo assessments of FB for deep brain stimulator targeting accuracy, which found average stereotactic errors of 1.4-2 mm [31].…”

Stereotactic implantation of deep brain stimulation electrodes: a review of technical systems, methods and emerging tools

“…MRI is the imaging modality of choice to visualise the anatomic targets. The sequence used depends on the chosen target structure: T 1 [22] or proton density imaging [54] is especially used for targeting of the globus pallidus, T 2 imaging for STN targeting [46,103,106], inversion recovery images are also beneficial for direct targeting of GPi and STN [99].…”

“…In general, these measurements are performed in millimetre steps before reaching the target and often measurements even go beyond the target structure. Most centres using microelectrode recording perform, as well, intraoperative stimulation along the trajectory using the microelectrodes stimulating in the microampere range [24,32,110] or macroelectrodes stimulating in the milliampere range for example using RF-or DBS stimulation electrodes [13,88,106]. In general this is done at the same measurement points as for MER, to evaluate the clinical effects with increasing stimulation voltage and to determine symptom reduction, the clinical therapeutic and side effect thresholds at each measurement point.…”

“…Postoperatively, a control of the final electrode position and the absence of haemorrhage via CT or MRI [50,100,106] is commonly part of the protocol (Fig. 2).…”

Guiding Deep Brain Stimulation interventions by fusing multimodal uncertainty regions

“…Nowadays the access path to the target region is planned using magnetic resonance imaging (MRI). However, in addition to the low signal-to-noise ratio, a major downside of this imaging modality is that the STN is not be visible in every patient [36]. Therefore, surgeons often use an atlas-based approach to locate the STN within the MRI data, a procedure which is prone to registration errors, is not patient specific, and lacks visual assessment.…”