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DBS microelectrode

Wenxi Tang, Penghui Wei, Jiapeng Huang, Na Zhang, Haipeng Zhou, Jinfeng Zhou, Qiang Zheng, Jianjun Li, Zhigang Wang
BACKGROUND: The asleep-awake-asleep (AAA) technique and laryngeal mask airway (LMA) is a common general anesthesia technique for deep brain stimulation (DBS) surgery. However, the LMA is not always the ideal artificial airway. In this report, we presented our experiences with nasotracheal intubation-extubation-intubation (IEI) and AAA techniques in DBS surgery for Parkinson's disease (PD) patients to meet the needs of surgery and ensure patients' safety and comfort. CASE PRESENTATION: Three PD patients scheduled for DBS surgery had to receive general anesthesia for various reasons...
January 17, 2019: BMC Anesthesiology
Dursun Aygün, Ümit Akın Dere, Onur Yildiz, Yasin Temel, Ersoy Kocabiçak
AIM: Deep brain stimulation (DBS) of the subthalamic nucleus is a preferred option for the treatment of motor symptoms in patients with Parkinson\'s disease (PD). Intraoperative microelectrode recording (MER), which guides the implantation of the DBS lead, can induce a microlesion effect (MLE) that results in motor symptom improvement. Although this phenomenon is well known, its quantitative impact remains unknown. In this prospective study, we investigated MER-induced MLE on the motor symptoms of 30 patients with PD...
October 17, 2018: Turkish Neurosurgery
Allen L Ho, Arjun V Pendharkar, Ryan Brewster, Derek L Martinez, Richard A Jaffe, Linda W Xu, Kai J Miller, Casey H Halpern
BACKGROUND: Modern robotic-assist surgical systems have revolutionized stereotaxy for a variety of procedures by increasing operative efficiency while preserving and even improving accuracy and safety. However, experience with robotic systems in deep brain stimulation (DBS) surgery is scarce. OBJECTIVE: To present an initial series of DBS surgery performed utilizing a frameless robotic solution for image-guided stereotaxy, and report on operative efficiency, stereotactic accuracy, and complications...
January 9, 2019: Operative Neurosurgery (Hagerstown, Md.)
Alexander C Whiting, Joshua S Catapano, Corey T Walker, Jakub Godzik, Margaret Lambert, Francisco A Ponce
OBJECTIVE: Postoperative peri-lead edema (PLE) is a poorly understood complication of deep brain stimulation (DBS), which has been described sporadically in patients presenting with profound and often delayed symptoms. We performed a prospective evaluation of patients undergoing DBS to determine the frequency of and identify risk factors for PLE. METHODS: Patients underwent DBS electrode placement by a single physician. Postoperative magnetic resonance imaging (MRI) was performed approximately 6 weeks postoperatively in asymptomatic subjects and analyzed for presence of PLE...
December 27, 2018: World Neurosurgery
Barbara Carl, Miriam Bopp, Marko Gjorgjevski, Carina Oehrn, Lars Timmermann, Christopher Nimsky
OBJECTIVE: Deep brain stimulation (DBS) is an effective treatment for movement disorders. Stereotactic electrode placement can be guided by intraoperative imaging, which also allows an immediate intraoperative quality control. This paper is about implementation and refining a workflow applying intraoperative computed tomography (iCT) for DBS. METHODS: 18 patients underwent DBS with bilateral implantation of directional electrodes applying a 32-slice movable CT scanner in combination with microelectrode recording...
December 26, 2018: World Neurosurgery
Po-Hsun Tu, Zhuo-Hao Liu, Chiung Chu Chen, Wey Yil Lin, Amy L Bowes, Chin Song Lu, Shih-Tseng Lee
Objective: Magnetic resonance imaging fusion techniques guided by frame-based stereotactic computed tomography and microelectrode recordings are widely used to target the subthalamic nucleus. However, MRI is not always available. The aim of this study was to determine whether the indirect targeting of the subthalamic nucleus for deep brain stimulation using frame-based stereotactic computed tomography and microelectrode recording guidance in patients with advanced idiopathic Parkinson's disease was an effective and safe treatment and to determine the factors that contributed to outcome...
2018: Frontiers in Human Neuroscience
Carlos Guevara, Jose de Grazia, Pedro Vazquez, Pablo Baabor, Cristián Garrido, Melissa Martinez, Jaime Fuentes, Fabian Piedimonte, Marcos Baabor
We report a successful bilateral globus pallidus internus-deep brain stimulation (GPi-DBS) for a Parkinson disease (PD) patient with idiopathic normal pressure hydrocephalus (INPH) and an unusually long anterior commissure-posterior commissure (AC-PC) line. A 54-year-old man presented with a history of 3 months of severe shuffling gait, rigidity, slow movements of the left side limbs, and difficulty managing finances. A brain MRI revealed marked ventriculomegaly (Evans index = 0.42). The patient was diagnosed with INPH and a ventriculoperitoneal shunt was placed...
2018: Frontiers in Neurology
Tatsuya Sasaki, Ken Kuwahara, Ittetsu Kin, Mihoko Okazaki, Susumu Sasada, Aiko Shinko, Masahiro Kameda, Takao Yasuhara, Takashi Agari, Isao Date
BACKGROUND: Details of the somatotopy within the subthalamic nucleus (STN) are still poorly understood; however, the STN is a common target of deep brain stimulation (DBS) for Parkinson disease. OBJECTIVE: To examine somatotopic organization within the STN and identify optimal stimulation sites from 77 surgical cases with microelectrode recording. METHODS: STN-DBS was performed for 77 patients with Parkinson disease between 2010 and 2014. We performed passive movements of each joint and captured single neuronal activities to identify movement-related cells (MRCs)...
November 16, 2018: Operative Neurosurgery (Hagerstown, Md.)
Danesh Ashouri Vajari, Maria Vomero, Johannes B Erhardt, Ali Sadr, Juan S Ordonez, Volker A Coenen, Thomas Stieglitz
Deep brain stimulation (DBS) is a successful medical therapy for many treatment resistant neuropsychiatric disorders such as movement disorders; e.g., Parkinson's disease, Tremor, and dystonia. Moreover, DBS is becoming more and more appealing for a rapidly growing number of patients with other neuropsychiatric diseases such as depression and obsessive compulsive disorder. In spite of the promising outcomes, the current clinical hardware used in DBS does not match the technological standards of other medical applications and as a result could possibly lead to side effects such as high energy consumption and others...
October 10, 2018: Micromachines
Luka Milosevic, Robert Gramer, Tae Hyun Kim, Musleh Algarni, Alfonso Fasano, Suneil K Kalia, Mojgan Hodaie, Andres M Lozano, Milos R Popovic, William D Hutchison
Deep brain stimulation of certain target structures within the basal ganglia is an effective therapy for the management of the motor symptoms of Parkinson's disease. However, its mechanisms, as well as the pathophysiology of Parkinson's disease, are varied and complex. The classical model of Parkinson's disease states that symptoms may arise as a result of increased neuronal activity in the basal ganglia output nuclei due to downregulated GABAergic striato-nigral/-pallidal projections. We sought to investigate the stimulation and levodopa induced effects on inhibitory synaptic plasticity in these basal ganglia output nuclei, and to determine the clinical relevance of altered plasticity with respect to patients' symptoms...
November 2, 2018: Neurobiology of Disease
Feng Luo, Linda H Kim, Philippe Magown, M Sohail Noor, Zelma Ht Kiss
Deep brain stimulation (DBS) of the globus pallidus pars interna (GPi) is a highly effective therapy for movement disorders, yet its mechanism of action remains controversial. Inhibition of local neurons due to release of GABA from afferents to the GPi is a proposed mechanism in patients. Yet, high frequency stimulation (HFS) produces prolonged membrane depolarization mediated by cholinergic neurotransmission in endopeduncular neurons (EP, GPi-equivalent in rodent). We applied HFS while recording neuronal firing from an adjacent electrode during microelectrode mapping of GPi in awake patients (both male and female) with Parkinson disease (PD) and dystonia...
October 29, 2018: Journal of Neuroscience: the Official Journal of the Society for Neuroscience
Zaman Mirzadeh, Tsinsue Chen, Kristina M Chapple, Margaret Lambert, John P Karis, Rohit Dhall, Francisco A Ponce
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...
October 18, 2018: Operative Neurosurgery (Hagerstown, Md.)
Sheng-Tzung Tsai, Shee-Ping Chen, Sheng-Huang Lin, Shinn-Zong Lin, Shin-Yuan Chen
Objectives: We have shown that neuronal activity in the subthalamic nucleus (STN) in patients with Parkinson's disease can be accurately recorded during deep brain stimulation (DBS) with general anesthesia (GA). However, a vigorous passive range of motion (PROM) test might exert awakening effects on patients who are lightly anesthetized. We will explore the effects of PROM on the heart rate (HR) and mean arterial pressure (MAP) during microelectrode recording (MER) and confirm whether it facilitates identifying the sensory motor portion of the STN under GA...
October 2018: Ci Ji Yi Xue za Zhi, Tzu-chi Medical Journal
Kai Rui Wan, Tomasz Maszczyk, Angela An Qi See, Justin Dauwels, Nicolas Kon Kam King
OBJECTIVE: This study seeks to systematically review the selection of features and algorithms for machine learning and automation in deep brain stimulation surgery (DBS) for Parkinson's disease. This will assist in consolidating current knowledge and accuracy levels to allow greater understanding and research to be performed in automating this process, which could lead to improved clinical outcomes. METHODS: A systematic literature review search was conducted for all studies that utilized machine learning and DBS in Parkinson's disease...
January 2019: Clinical Neurophysiology: Official Journal of the International Federation of Clinical Neurophysiology
Andreas Nowacki, T A-K Nguyen, Gerd Tinkhauser, Katrin Petermann, Ines Debove, Roland Wiest, Claudio Pollo
BACKGROUND: Accurate interindividual comparability of deep brain stimulation (DBS) lead locations in relation to the surrounding anatomical structures is of eminent importance to define and understand effective stimulation areas. The objective of the current work is to compare the accuracy of the DBS lead localisation relative to the STN in native space with four recently developed three-dimensional subcortical brain atlases in the MNI template space. Accuracy is reviewed by anatomical and volumetric analysis as well as intraoperative electrophysiological data...
2018: NeuroImage: Clinical
Mahsa Malekmohammadi, Hiro Sparks, Nicholas AuYong, Andrew Hudson, Nader Pouratian
BACKGROUND/AIMS: There are reports that microelectrode recording (MER) can be performed under certain anesthetized conditions for functional confirmation of the optimal deep brain stimulation (DBS) target. However, it is generally accepted that anesthesia affects MER. Due to a potential role of local field potentials (LFPs) in DBS functional mapping, we characterized the effect of propofol on globus pallidus interna (GPi) and externa (GPe) LFPs in Parkinson disease (PD) patients. METHODS: We collected LFPs in 12 awake and anesthetized PD patients undergoing DBS implantation...
2018: Stereotactic and Functional Neurosurgery
Volker A Coenen, Bastian Sajonz, Marco Reisert, Jan Bostroem, Bettina Bewernick, Horst Urbach, Carolin Jenkner, Peter C Reinacher, Thomas E Schlaepfer, Burkhard Mädler
Background: Deep brain stimulation (DBS) of the superolateral branch of the medial forebrain bundle (slMFB) emerges as a - yet experimental - treatment for major depressive disorder (MDD) and other treatment refractory psychiatric diseases. First experiences have been reported from two open label pilot trials in major depression (MDD) and long-term effectiveness for MDD (50 months) has been reported. Objective: To give a detailed description of the surgical technique for DBS of the superolateral branch of the medial forebrain bundle (slMFB) in MDD...
2018: NeuroImage: Clinical
Andreas Horn, Ningfei Li, Till A Dembek, Ari Kappel, Chadwick Boulay, Siobhan Ewert, Anna Tietze, Andreas Husch, Thushara Perera, Wolf-Julian Neumann, Marco Reisert, Hang Si, Robert Oostenveld, Christopher Rorden, Fang-Cheng Yeh, Qianqian Fang, Todd M Herrington, Johannes Vorwerk, Andrea A Kühn
Deep brain stimulation (DBS) is a highly efficacious treatment option for movement disorders and a growing number of other indications are investigated in clinical trials. To ensure optimal treatment outcome, exact electrode placement is required. Moreover, to analyze the relationship between electrode location and clinical results, a precise reconstruction of electrode placement is required, posing specific challenges to the field of neuroimaging. Since 2014 the open source toolbox Lead-DBS is available, which aims at facilitating this process...
January 1, 2019: NeuroImage
Sander Bus, Gian Pal, Bichun Ouyang, Pepijn van den Munckhof, Maarten Bot, Sepehr Sani, Leo Verhagen Metman
BACKGROUND/AIMS: Microelectrode recording (MER)-guided deep brain stimulation (DBS) aims to place the DBS lead in the optimal electrophysiological target. When single-track MER or test stimulation yields suboptimal results, trajectory adjustments are made. The accuracy of these trajectory adjustments is unknown. Intraoperative computed tomography can visualize the microelectrode (ME) and verify ME adjustments. We aimed to determine the accuracy of ME movements in patients undergoing MER-guided DBS...
2018: Stereotactic and Functional Neurosurgery
Yuval Duchin, Reuben R Shamir, Remi Patriat, Jinyoung Kim, Jerrold L Vitek, Guillermo Sapiro, Noam Harel
OBJECTIVE: Deep brain stimulation (DBS) requires accurate localization of the anatomical target structure, and the precise placement of the DBS electrode within it. Ultra-high field 7 Tesla (T) MR images can be utilized to create patient-specific anatomical 3D models of the subthalamic nuclei (STN) to enhance pre-surgical DBS targeting as well as post-surgical visualization of the DBS lead position and orientation. We validated the accuracy of the 7T imaging-based patient-specific model of the STN and measured the variability of the location and dimensions across movement disorder patients...
2018: PloS One
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