Optimization of Microelectrode Recording in DBS Surgery Using Intraoperative CT.

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Optimization of Microelectrode Recording in DBS Surgery Using Intraoperative CT.

World Neurosurg. 2017 Apr 10;:

Authors: Kochanski RB, Bus S, Pal G, Metman LV, Sani S

Abstract
BACKGROUND: Microelectrode recording (MER) is used to confirm targeting accuracy during deep brain stimulation (DBS) surgery. We describe a technique using intraoperative CT extrapolation (iCTE) to predetermine and adjust the trajectory of the guide tube in order to improve microelectrode targeting accuracy. We hypothesized that this technique would decrease the number of MER tracks and operative time, while increasing the recorded length of subthalamic nucleus (STN).
METHODS: Thirty-nine patients with Parkinson's disease who underwent STN DBS before the iCTE method were compared to 33 patients undergoing STN DBS using iCTE. Before dural opening, a guide tube was inserted and rested on dura. Intraoperative CT (iCT) was obtained, and a trajectory was created along the guide tube and extrapolated to target using targeting software. If needed, headstage adjustments were made to correct for error. The guide tube was inserted and MER ensued. ICT was performed with the microelectrode tip at target. Coordinates were compared with planned/adjusted track coordinates. Radial error between MER track and planned/adjusted track was calculated. Cases before and after implementation of iCTE were compared to determine its impact on operative time, number of MER tracks and recorded STN length.
RESULTS: ICTE reduced average radial MER track error from 1.90±0.12 mm(n=54) to 0.84±0.09 mm(n=49, p<0.001) while reducing operative time for bilateral lead placement from 272±9 min(n=30) to 233±10 min(n=24, p<0.001).The average MER tracks per hemisphere was reduced from 2.24±0.13 mm(n=66) to 1.75±0.09 mm(n=63, p<0.001) while the percentage of hemispheres requiring a single MER track for localization increased from 29% (n=66) to 43% (n=63). The average length of recorded STN increased from 4.01±0.3 mm(n=64) to 4.75±0.28 mm(n=56, p<0.05).
CONCLUSION: iCTE improves microelectrode accuracy, increases the first pass recorded length of STN, while reducing operative time. Further studies are needed to determine whether this technique leads to less morbidity and improved clinical outcomes.

PMID: 28408262 [PubMed - as supplied by publisher]

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