• Simultaneous bilateral MER-guided Stereotactic implantation of deep brain stimulation electrodes.

    Final Number:

    Erich Talamoni Fonoff PhD; William Omar Contreras Lopez PhD; RCR Martinez; Jairo Angelos MD; AC Azevedo; Jessie Navarro; Manoel Jacobsen Teixeira

    Study Design:
    Clinical Trial

    Subject Category:
    Movement Disorders

    Meeting: 2014 ASSFN Biennial Meeting

    Introduction: Bilateral DBS has become one of the most important neurosurgical techniques for the treatment of many neuropsychiatric diseases. In recent years, many efforts have been made in order to improve safety, accuracy and comfort for the patient treated by DBS. A cardinal fact is that currently the surgical step-by-step procedure involves two unilateral sequential hemispherical implants what increases surgical time and also CSF leak increasing the risk of brain shifting. In this case series we performed bilateral, simultaneous implant of deep brain electrodes, as a strategy to shorten surgical procedure avoiding major brain shift. The aim of this work was to demonstrate technique feasibility and advantages of performing bilateral simultaneous electrodes implant in the subthalamic nucleus (STN) from a case series of 10 patients with Parkinson´s disease (PD) and 1 with primary Dystonia.

    Methods: Two half-arcs were mounted simultaneous on a Micromar® stereotactic frame allowing simultaneous bilateral access. After two simultaneous precoronal approaches, one to five cannulas were introduced through two microdrives until 10 mm before target, microrecording was performed simultaneously at every 0.5-mm until target. The number of tracks used for macroelectrode insertion ranged from 1 to 3 (median 1) and the macroelectrode in track eliciting the best clinical outcome was subsequently replaced by a permanent electrode (Medtronic® type 3389). Immediately after the procedure, the position of each permanent electrode was verified by orthogonal X-ray images.

    Results: No dislocation higher than 1-mm was found in any patient. The procedure presented major advantages over traditional unilateral individual consecutive approach, such as: real time recorded bilateral neuronal activity, high accuracy between planning and surgery documented by better clinical outcomes most probably due to avoiding of major brain shifting, and over 1 hour shorter total operating time with a total intracranial surgical time of 116.3 +/- 22 min.

    Conclusions: Bilateral simultaneous implant of deep brain electrodes had the advantage of considerable time saved, simultaneous micro electrode recording and minor brain shifting making DBS surgery more accurately.

    Patient Care: The authors present the clinical implementation of bilateral simultaneous micro-electrode recording (MER) and implantation of deep brain stimulation (DBS) system, which may lead to shorten the actual DBS surgical time worldwide.

    Learning Objectives: To our knwodlege is the biggest reported series of bilateral simultaneous implant of electrodes, at the conclusion of the session participans should be interested in trying this alternative surgical approach.

    References: Acta Neurochir (Wien). 2013 Sep;155(9):1675-6. doi: 10.1007/s00701-013-1814-x. Epub 2013 Jul 9. Bilateral simultaneous implant of electrodes within the subthalamic nucleus. Feasibility and advantages. Franzini A, Messina G, Rizzi M, Cordella R, Mazzone P.

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