Direct localization of subthalamic nucleus supplemented by single-track electrophysiological guidance in deep brain stimulation lead implantation: techniques and clinical results.

BACKGROUND/AIMS: In subthalamic nucleus (STN) deep brain stimulation (DBS) lead implantation, it is still controversial whether it is more appropriate to employ indirect or direct methods in magnetic resonance imaging (MRI)-based tentative targeting and to select single- or multiple-track recording in electrophysiological definitive targeting. The efficacy of single-track electrophysiological recording through direct targeting was compared with the conventional indirect targeting methods in light of the identified STN thickness and clinical results.

METHODS

The identified mean STN thickness, pre- and 6-month postoperative Unified Parkinson's Disease Rating Scale (UPDRS), dose change of L-dopa and dopaminergic agonists were compared in indirect (midcommissural point-based, 44 procedures) and direct (image-based, 44 procedures) targeting methods.

RESULTS

The identified mean STN thickness was significantly greater in the group employing direct methods. For evaluation of the UPDRS, a significant scale improvement was noted in part 2 OFF for both groups. Significant scale improvements occurred in parts 3 and 4 in the group employing the direct method. Both groups revealed significant L-dopa dose reduction with the tendency towards a greater reduction in the group employing the direct method.

CONCLUSION

MRI-based direct targeting supplemented by single-track recording could be justified as a standard for DBS lead implantation to achieve better clinical results.