Abstract
BACKGROUND Deep brain stimulation (DBS) is well-established, evidence-based therapy for Parkinson disease, essential tremor, and primary dystonia. Clinical outcome studies have recently shown that asleep DBS lead placement, performed using intraoperative imaging with stereotactic accuracy as the surgical endpoint, has motor outcomes comparable to traditional awake DBS using microelectrode recording (MER), but with shorter case times and improved speech fluency.
OBJECTIVE To identify procedural variables in DBS surgery associated with improved surgical efficiency and stereotactic accuracy.
METHODS Retrospective review of 323 cases with 546 leads placed (August 2011-October 2014). In 52% (n=168) of cases, patients were asleep under general anesthesia without MER. Multivariate regression identified independent predictors of reduced surgery time and improved stereotactic accuracy.
RESULTS MER was an independent contributor to increased procedure time (+44 min; P=.03). Stereotactic accuracy was better in asleep patients. Accuracy was improved with frame-based stereotaxy at head of bed 0 degrees vs frameless stereotaxy at head of bed 30 degrees. Improved accuracy was also associated with shorter procedures (r=0.17; P=.049). Vector errors were evenly distributed around the planned target for the globus pallidus internus, but directionally skewed for the subthalamic (medial-posterior) and ventral intermediate nuclei (medial-anterior).
CONCLUSION Distinct procedural variables in DBS surgery are associated with reduced case times and improved stereotactic accuracy.