Intraoperative MRI for deep brain stimulation lead placement in Parkinson’s disease: 1 year motor and neuropsychological outcomes
- 586 Downloads
Traditional deep brain stimulation requires intraoperative neurophysiological confirmation of electrode placement. Recently, purely image guided methods are being evaluated as to their clinical efficacy in comparison to surgery using microelectrode recordings. We used the ClearPoint® system to place electrodes in both the subthalamic nucleus and globus pallidus internus in patients with advanced Parkinson’s disease. Off medication UPDRS scores were assessed before and 1 year after surgery as well as pre- and 1 year post-operative neuropsychological outcomes. Targeting precision was also assessed. Patients implanted in the subthalamic nucleus improved by 46.2 % in their UPDRS scores post-operatively (p = 0.03) whereas the globus pallidus group improved by 41 % (p = 0.06). There were no significant adverse neuropsychological outcomes in either group of patients. Mean radial error for the STN group was 1.2 ± 0.7 mm and for the GPi group 0.8 mm ± 0.3 mm. Image guided DBS using the ClearPoint®system has high targeting precision with robust clinical outcomes. Our data are in accord with recent studies using the same or similar technologies and provide a rationale for a large comparative study of image-guided versus microelectrode guided DBS.
KeywordsDeep brain stimulation Globus pallidus Intraoperative MRI Parkinson’s disease Subthalamic nucleus
Compliance with ethical standards
Conflicts of interest
The authors report no pertinent financial disclosures.
This study has been approved by the appropriate ethics committee and has therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.
- 4.Chabardes S, Isnard S, Castrioto A, Oddoux M, Fraix V, Carlucci L, Payen JF, Krainik A, Krack P, Larson P, Le Bas JF (2015) Surgical implantation of STN-DBS leads using intraoperative MRI guidance: technique, accuracy, and clinical benefit at 1-year follow-up. Acta Neurochir (Wien) 157:729–737CrossRefGoogle Scholar
- 6.Follett KA, Weaver FM, Stern M, Hur K, Harris CL, Luo P, Marks WJ Jr, Rothlind J, Sagher O, Moy C, Pahwa R, Burchiel K, Hogarth P, Lai EC, Duda JE, Holloway K, Samii A, Horn S, Bronstein JM, Stoner G, Starr PA, Simpson R, Baltuch G, De Salles A, Huang GD, Reda DJ (2010) Pallidal versus subthalamic deep-brain stimulation for Parkinson’s disease. N Eng J Med 362:2077–2091CrossRefGoogle Scholar
- 13.Mascott CR, Sol JC, Bousquet P, Lagarrigue J, Lazorthes Y, Lauwers-Cances V (2006) Quantification of true in vivo (application) accuracy in cranial image-guided surgery: influence of mode of patient registration. Neurosurgery 59:ONS146-156 (discussion ONS146-156) Google Scholar
- 15.Mirzadeh Z, Chapple K, Lambert M, Evidente VG, Mahant P, Ospina MC, Samanta J, Moguel-Cobos G, Salins N, Lieberman A, Troster AI, Dhall R, Ponce FA (2016) Parkinson’s disease outcomes after intraoperative CT-guided “asleep” deep brain stimulation in the globus pallidus internus. J Neurosurg 124(4):902–907CrossRefPubMedGoogle Scholar
- 17.Odekerken VJ, van Laar T, Staal MJ, Mosch A, Hoffmann CF, Nijssen PC, Beute GN, van Vugt JP, Lenders MW, Contarino MF, Mink MS, Bour LJ, van den Munckhof P, Schmand BA, de Haan RJ, Schuurman PR, de Bie RM (2013) Subthalamic nucleus versus globus pallidus bilateral deep brain stimulation for advanced Parkinson’s disease (NSTAPS study): a randomised controlled trial. Lancet Neurol 12:37–44CrossRefPubMedGoogle Scholar
- 18.Okun MS, Gallo BV, Mandybur G, Jagid J, Foote KD, Revilla FJ, Alterman R, Jankovic J, Simpson R, Junn F, Verhagen L, Arle JE, Ford B, Goodman RR, Stewart RM, Horn S, Baltuch GH, Kopell BH, Marshall F, Peichel D, Pahwa R, Lyons KE, Troster AI, Vitek JL, Tagliati M (2012) Subthalamic deep brain stimulation with a constant-current device in Parkinson’s disease: an open-label randomised controlled trial. Lancet Neurol 11:140–149CrossRefPubMedGoogle Scholar
- 24.Starr PA, Martin AJ, Ostrem JL, Talke P, Levesque N, Larson PS (2010) Subthalamic nucleus deep brain stimulator placement using high-field interventional magnetic resonance imaging and a skull-mounted aiming device: technique and application accuracy. J Neurosurg 112:479–490CrossRefPubMedPubMedCentralGoogle Scholar
- 25.Temel Y, Wilbrink P, Duits A, Boon P, Tromp S, Ackermans L, van Kranen-Mastenbroek V, Weber W, Visser-Vandewalle V (2007) Single electrode and multiple electrode guided electrical stimulation of the subthalamic nucleus in advanced Parkinson’s disease. Neurosurgery 61:346–355 (discussion 355–347) PubMedGoogle Scholar
- 26.Weaver FM, Follett KA, Stern M, Luo P, Harris CL, Hur K, Marks WJ Jr, Rothlind J, Sagher O, Moy C, Pahwa R, Burchiel K, Hogarth P, Lai EC, Duda JE, Holloway K, Samii A, Horn S, Bronstein JM, Stoner G, Starr PA, Simpson R, Baltuch G, De Salles A, Huang GD, Reda DJ (2012) Randomized trial of deep brain stimulation for Parkinson disease: thirty-six-month outcomes. Neurology 79:55–65CrossRefPubMedPubMedCentralGoogle Scholar
- 27.Williams A, Gill S, Varma T, Jenkinson C, Quinn N, Mitchell R, Scott R, Ives N, Rick C, Daniels J, Patel S, Wheatley K (2010) Deep brain stimulation plus best medical therapy versus best medical therapy alone for advanced Parkinson’s disease (PD SURG trial): a randomised, open-label trial. Lancet Neurol 9:581–591CrossRefPubMedPubMedCentralGoogle Scholar