Abstract
Deep brain stimulation (DBS) is a well-established treatment for movement disorders, such as Parkinson’s disease (PD), essential tremor, and dystonia. Best clinical effects depend on precise placement of electrodes in the motor territory of the target nuclei by stereotactic neurosurgery. Patient selection is important. Careful surgical interventions and microelectrode recordings are necessary in aged patients. General anesthesia can be required for frame placement in dystonia case. Correct framing from three directions should be verified. Combinations of AC(anterior commissure)–PC(posterior commissure)-based targeting and imaging-based targeting may approach the optimal target. Care should be taken for continuous cerebrospinal fluid leak after dural opening. Optimal trajectory should be selected to avoid injuries of cortical and sulcal vessels, or lateral ventricle penetration, which may increase hemorrhagic risk and electrode malposition. Because of the brain shift as the operating time progresses, target should be modified according to intraoperative neurophysiological examinations such as microelectrode recording and macroelectrode stimulation test. Implantation of devices should be reminded of delayed skin complication or infection. On the background of extended application, surgical technique of DBS would be modified in the future, preserving principal concept and surgical technique.
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Nishibayashi, H., Itakura, T. (2015). Surgical Technique of Brain Stimulation. In: Itakura, T. (eds) Deep Brain Stimulation for Neurological Disorders. Springer, Cham. https://doi.org/10.1007/978-3-319-08476-3_6
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DOI: https://doi.org/10.1007/978-3-319-08476-3_6
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