The Accuracy of Imaging Guided Targeting with Microelectrode Recoding in Subthalamic Nucleus for Parkinson’s Disease: A Single-Center Experience

• Published in: Journal of Parkinson's disease Vol. 12; no. 3; pp. 897 - 903
• Main Authors: Zheng, Zhe, Zhu, Zhoule, Ying, Yuqi, Jiang, Hongjie, Wu, Hemmings, Tian, Jun, Luo, Wei, Zhu, Junming
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01.01.2022; IOS Press BV; IOS Press
• Subjects: Deep brain stimulation; Deep Brain Stimulation - methods; Electrical stimuli; Electrodes; Electrodes, Implanted; Humans; Magnetic resonance imaging; Magnetic Resonance Imaging - methods; Microelectrodes; Movement disorders; Neurodegenerative diseases; Neuroimaging; Parkinson Disease - surgery; Parkinson Disease - therapy; Parkinson's disease; Physiology; Research Report; Retrospective Studies; Solitary tract nucleus; Subthalamic nucleus; Subthalamic Nucleus - diagnostic imaging; Subthalamic Nucleus - physiology; Subthalamic Nucleus - surgery; Accuracy; microelectrode recording; subthalamic nucleus; deep brain stimulation; Parkinson’s disease
• ISSN: 1877-7171; 1877-718X
• DOI: 10.3233/JPD-213095

Background: Accurate electrode targeting was essential for the efficacy of deep brain stimulation (DBS). There is ongoing debate about the necessary of microelectrode recording (MER) in subthalamic nucleus (STN)-DBS surgery for accurate targeting. Objective: This study aimed to analyze the accuracy of imaging-guided awake DBS with MER in STN for Parkinson’s disease in a single center. Methods: The authors performed a retrospective analysis of 161 Parkinson’s disease patients undergoing STN-DBS at our center from March 2013 to June 2021. The implantation was performed by preoperative magnetic resonance imaging (MRI)-based direct targeting with intraoperative MER and macrostimulation testing. 285 electrode tracks with preoperative and postoperative coordinates were included to calculate the placement error in STN targeting. Results: 85.9% of electrodes guided by preoperative MRI were implanted without intraoperative adjustment. 31 (10.2%) and 12 (3.9%) electrodes underwent intraoperative adjustment due to MER and intraoperative testing, respectively. We found 86.2% (245/285) of electrodes with trajectory error ≤2 mm. The MER physiological signals length < 4 mm and ≥4 mm group showed trajectory error > 2 mm in 38.0% and 8.8% of electrodes, respectively. Compared to non-adjustment electrodes, the final positioning of MER-adjusted electrodes deviated from the center of STN. Conclusion: The preoperative MRI guided STN targeting results in approximately 14% cases that require electrode repositioning. MER physiological signals length < 4 mm at first penetration implied deviation off planned target. MER combined with intraoperative awake testing served to rescue such deviation based on MRI alone.