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.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
Anderson VC, Burchiel KJ, Hogarth P, Favre J, Hammerstad JP (2005) Pallidal vs subthalamic nucleus deep brain stimulation in Parkinson disease. Arch Neurol 62:554–560
Andrade-Souza YM, Schwalb JM, Hamani C, Eltahawy H, Hoque T, Saint-Cyr J, Lozano AM (2005) Comparison of three methods of targeting the subthalamic nucleus for chronic stimulation in Parkinson’s disease. Neurosurgery 56:360–368 (discussion 360–368)
Burchiel KJ, McCartney S, Lee A, Raslan AM (2013) Accuracy of deep brain stimulation electrode placement using intraoperative computed tomography without microelectrode recording. J Neurosurg 119:301–306
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) 157:729–737
Ellis TM, Foote KD, Fernandez HH, Sudhyadhom A, Rodriguez RL, Zeilman P, Jacobson CET, Okun MS (2008) Reoperation for suboptimal outcomes after deep brain stimulation surgery. Neurosurgery 63:754–760 (discussion 760–751)
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 362:2077–2091
Foltynie T, Zrinzo L, Martinez-Torres I, Tripoliti E, Petersen E, Holl E, Aviles-Olmos I, Jahanshahi M, Hariz M, Limousin P (2011) MRI-guided STN DBS in Parkinson’s disease without microelectrode recording: efficacy and safety. J Neurol Neurosurg Psychiatry 82:358–363
Homack S, Lee D, Riccio CA (2005) Test review: Delis–Kaplan executive function system. J Clin Exp Neuropsychol 27:599–609
Laitinen LV, Bergenheim AT, Hariz MI (1992) Leksell’s posteroventral pallidotomy in the treatment of Parkinson’s disease. J Neurosurg 76:53–61
Lang AE, Benabid AL, Koller WC, Lozano AM, Obeso JA, Olanow CW, Pollak P (1995) The core assessment program for intracerebral transplantation. Mov Disord 10:527–528
Larson PS, Starr PA, Bates G, Tansey L, Richardson RM, Martin AJ (2012) An optimized system for interventional magnetic resonance imaging-guided stereotactic surgery: preliminary evaluation of targeting accuracy. Neurosurgery 70:95–103 (discussion 103)
Maciunas RJ, Galloway RL Jr, Latimer JW (1994) The application accuracy of stereotactic frames. Neurosurgery 35:682–694 (discussion 694–685)
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)
Mirzadeh Z, Chapple K, Lambert M, Dhall R, Ponce FA (2014) Validation of CT-MRI fusion for intraoperative assessment of stereotactic accuracy in DBS surgery. Mov Disord 29:1788–1795
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):902–907
Odekerken VJ, Boel JA, Geurtsen GJ, Schmand BA, Dekker IP, de Haan RJ, Schuurman PR, de Bie RM (2015) Neuropsychological outcome after deep brain stimulation for Parkinson disease. Neurology 84:1355–1361
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 12:37–44
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 11:140–149
Ostrem JL, Galifianakis NB, Markun LC, Grace JK, Martin AJ, Starr PA, Larson PS (2013) Clinical outcomes of PD patients having bilateral STN DBS using high-field interventional MR-imaging for lead placement. Clin Neurol Neurosurg 115:708–712
Ostrem JL, Ziman N, Galifianakis NB, Starr PA, Luciano MS, Katz M, Racine CA, Martin AJ, Markun LC, Larson PS (2016) Clinical outcomes using ClearPoint interventional MRI for deep brain stimulation lead placement in Parkinson’s disease. J Neurosurg 124(4):908–916
Patel NK, Plaha P, Gill SS (2007) Magnetic resonance imaging-directed method for functional neurosurgery using implantable guide tubes. Neurosurgery 61:358–365 (discussion 365-356)
Randolph C, Tierney MC, Mohr E, Chase TN (1998) The repeatable battery for the assessment of neuropsychological status (RBANS): preliminary clinical validity. J Clin Exp Neuropsychol 20:310–319
Starr PA, Markun LC, Larson PS, Volz MM, Martin AJ, Ostrem JL (2014) Interventional MRI-guided deep brain stimulation in pediatric dystonia: first experience with the ClearPoint system. J Neurosurg Pediatr 14:400–408
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 112:479–490
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)
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 79:55–65
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 9:581–591
Zrinzo L, Foltynie T, Limousin P, Hariz M (2012) Image-verified deep brain stimulation reduces risk and cost with no apparent impact on efficacy. Mov Disord 27:1585–1586 (author reply 1586–1587)
Zrinzo L, Foltynie T, Limousin P, Hariz MI (2012) Reducing hemorrhagic complications in functional neurosurgery: a large case series and systematic literature review. J Neurosurg 116:84–94
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.
About this article
Cite this article
Sidiropoulos, C., Rammo, R., Merker, B. et al. Intraoperative MRI for deep brain stimulation lead placement in Parkinson’s disease: 1 year motor and neuropsychological outcomes. J Neurol 263, 1226–1231 (2016). https://doi.org/10.1007/s00415-016-8125-0
- Deep brain stimulation
- Globus pallidus
- Intraoperative MRI
- Parkinson’s disease
- Subthalamic nucleus