Introduction: Deep brain stimulation efficacy is dependent on adequate electrode implantation. Traditionally, intraoperative physiology with microelectrode recording (MER) is used to refine stereotactic accuracy during awake electrode implantation. Recently, portable imaging systems such as the O-arm have become widely available and can be used in isolation or in association with MER to guide DBS lead placement. We evaluated how the routine use of the O-arm affected DBS surgery safety, efficiency and outcomes.
Methods: Two cohorts of patients with Parkinson's disease who underwent MER-guided awake subthalamic DBS lead implantation with and without O-arm were compared. Based on a retrospective chart review, we examined the total number of microelectrode and macroeletrode passes during each surgery, procedure duration, surgical complications, lead revisions and motor outcomes.
Results: The mean total number of passes per side was 3.88 (SD=1.48) in the group without O-arm utilization, compared to 2.42 (SD=0.83) in the group with O-arm usage (p<0.001). A significant reduction was also found in procedure duration (p=0.016), with procedure length reduced by 22.8 minutes with the O-arm. No differences were found in motor outcomes between groups. The mean reduction of UPDRS III was 57.6% in the patients who underwent surgery without the O-arm and 52.6% in the patients that underwent surgery with the O-arm.
Conclusions: The use of the O-arm during DBS surgery is associated with a significant reduction in the total number of brain penetrations as well as reduced surgical time, without changes in outcome.
Patient Care: Using the O-arm we reduced the brain cannulations as well as surgical time in DBS surgeries
Learning Objectives: By the conclusion of this session, participants should be able to: 1 Describe how to use O-arm in DBS surgery in association with microelectrode recording 2) Discuss the pros and cons of using this tool in the clinical practice.
References: 1. Sharma M, Deogaonkar M. Accuracy and safety of targeting using intraoperative “o-arm” during placement of deep brain stimulation electrodes without electrophysiological recordings. J Clin Neurosci. 2016;27(2016):80-86. doi:10.1016/j.jocn.2015.06.036.
2. Caire F, Gantois C, Torny F, Ranoux D, Maubon A, Moreau JJ. Intraoperative use of the medtronic O-arm for deep brain stimulation procedures. Stereotact Funct Neurosurg. 2010;88(2):109-114. doi:10.1159/000280823.
3. Servello D, Zekaj E, Saleh C, Pacchetti C, Porta M. The pros and cons of intraoperative CT scan in evaluation of deep brain stimulation lead implantation: A retrospective study. Surg Neurol Int. 2016;7(20):551. doi:10.4103/2152-7806.187534.
4. Deuschl G. A Randomized Trial of Deep-Brain Stimulation for Parkinson. N Engl J Med. 2006;355:896-908. doi:10.1056/NEJMoa060281.
5. Deep-Brain Stimulation for Parkinson’s Disease Study Group. Deep-brain stimulation of the subthalamic nucleus or the pars interna of the globus pallidus in Parkinson’s disease. N Engl J Med. 2001;345(13):956-963. doi:10.1056/NEJMoa000827.
6. Temel Y, Wilbrink P, Duits A, et al. Single electrode and multiple electrode guided electrical stimulation of the subthalamic nucleus in advanced Parkinson’s disease. Neurosurgery. 2007;61(5 Suppl 2):346-55-7. doi:10.1227/01.neu.0000303993.82149.98.
7. Machado A, Rezai AR, Kopell BH, Gross RE, Sharan AD, Benabid A-L. Deep brain stimulation for Parkinson’s disease: surgical technique and perioperative management. Mov Disord. 2006;21 Suppl 1:S247-58. doi:10.1002/mds.20959.