MicroTargeting® platform: an individual stereotaxic device in functional neurosurgery

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Abstract

Object: Deep brain stimulation of the Nucleus subthalamicus (DBS-STN) results in an improvement of cardinal symptoms of Parkinson disease (PD) and allows a significant reduction of medication. Because of the potential risk of inaccuracies during image acquisition, planning procedure, placement of test electrodes and final electrode insertion a microTargeting® platform, FHC Company, Germany, as an example of automation in stereotaxic neurosurgery was used.

Materials and methods: A 65-years-old male patient with PD with severe motor dysfunctions was selected for DBS-STN. Preoperatively and just before image acquisition (CT, T1w-, T2w-MRI) three WayPointTM anchors per side were implanted in the skull for further definition of entry and target points, postprocessing and for creation of an individual stereotaxic platform, which was fixed with the patient’s head intraoperatively.

Results: The “MicroTargeting” system allowed a precise detection of the STN and definition of electrode trajectories, which was confirmed intraoperatively by microelectrode recording and macrostimulation. At a frequency of 130 Hz, 1.5 mA and 60 μ s pulse width the typical motor dysfunction disappeared and no stimulation associated side effects could be registered. Adjustment and reduction of medication followed.

Conclusion: MicroTargeting® platform replaced traditional target arch and electrode positioning system in an excellent way and increased the patient’s comfort. With the individual stereotaxic platform an example for automation was found, which has the potential to increase the patient’s and neurosurgeon’s safety.

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