How accurately are subthalamic nucleus electrodes implanted relative to the ideal stimulation location for Parkinson's disease?

<h4>Introduction</h4>The efficacy of subthalamic nucleus (STN) deep brain stimulation (DBS) in Parkinson's disease (PD) depends on how closely electrodes are implanted relative to an individual's ideal stimulation location. Yet, previous studies have assessed how closely electr...

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Autores principales:	Patrick Pearce, Kristian Bulluss, San San Xu, Boaz Kim, Marko Milicevic, Thushara Perera, Wesley Thevathasan
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/a5e2b8d2a8154900996f0da28e817eaf
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spelling	oai:doaj.org-article:a5e2b8d2a8154900996f0da28e817eaf2021-12-02T20:09:13ZHow accurately are subthalamic nucleus electrodes implanted relative to the ideal stimulation location for Parkinson's disease?1932-620310.1371/journal.pone.0254504https://doaj.org/article/a5e2b8d2a8154900996f0da28e817eaf2021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0254504https://doaj.org/toc/1932-6203<h4>Introduction</h4>The efficacy of subthalamic nucleus (STN) deep brain stimulation (DBS) in Parkinson's disease (PD) depends on how closely electrodes are implanted relative to an individual's ideal stimulation location. Yet, previous studies have assessed how closely electrodes are implanted relative to the planned location, after homogenizing data to a reference. Thus here, we measured how accurately electrodes are implanted relative to an ideal, dorsal STN stimulation location, assessed on each individual's native imaging. This measure captures not only the technical error of stereotactic implantation but also constraints imposed by planning a suitable trajectory.<h4>Methods</h4>This cross-sectional study assessed 226 electrodes in 113 consecutive PD patients implanted with bilateral STN-DBS by experienced clinicians utilizing awake, microelectrode guided, surgery. The error (Euclidean distance) between the actual electrode trajectory versus a nominated ideal, dorsal STN stimulation location was determined in each hemisphere on native imaging and predictive factors sought.<h4>Results</h4>The median electrode location error was 1.62 mm (IQR = 1.23 mm). This error exceeded 3 mm in 28/226 electrodes (12.4%). Location error did not differ between hemispheres implanted first or second, suggesting brain shift was minimised. Location error did not differ between electrodes positioned with (48/226), or without, a preceding microelectrode trajectory shift (suggesting such shifts were beneficial). There was no relationship between location error and case order, arguing against a learning effect.<h4>Discussion/conclusion</h4>The proximity of STN-DBS electrodes to a nominated ideal, dorsal STN, stimulation location is highly variable, even when implanted by experienced clinicians with brain shift minimized, and without evidence of a learning effect. Using this measure, we found that assessments on awake patients (microelectrode recordings and clinical examination) likely yielded beneficial intraoperative decisions to improve positioning. In many patients the error is likely to have reduced therapeutic efficacy. More accurate methods to implant STN-DBS electrodes relative to the ideal stimulation location are needed.Patrick PearceKristian BullussSan San XuBoaz KimMarko MilicevicThushara PereraWesley ThevathasanPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 7, p e0254504 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Patrick Pearce Kristian Bulluss San San Xu Boaz Kim Marko Milicevic Thushara Perera Wesley Thevathasan How accurately are subthalamic nucleus electrodes implanted relative to the ideal stimulation location for Parkinson's disease?
description	<h4>Introduction</h4>The efficacy of subthalamic nucleus (STN) deep brain stimulation (DBS) in Parkinson's disease (PD) depends on how closely electrodes are implanted relative to an individual's ideal stimulation location. Yet, previous studies have assessed how closely electrodes are implanted relative to the planned location, after homogenizing data to a reference. Thus here, we measured how accurately electrodes are implanted relative to an ideal, dorsal STN stimulation location, assessed on each individual's native imaging. This measure captures not only the technical error of stereotactic implantation but also constraints imposed by planning a suitable trajectory.<h4>Methods</h4>This cross-sectional study assessed 226 electrodes in 113 consecutive PD patients implanted with bilateral STN-DBS by experienced clinicians utilizing awake, microelectrode guided, surgery. The error (Euclidean distance) between the actual electrode trajectory versus a nominated ideal, dorsal STN stimulation location was determined in each hemisphere on native imaging and predictive factors sought.<h4>Results</h4>The median electrode location error was 1.62 mm (IQR = 1.23 mm). This error exceeded 3 mm in 28/226 electrodes (12.4%). Location error did not differ between hemispheres implanted first or second, suggesting brain shift was minimised. Location error did not differ between electrodes positioned with (48/226), or without, a preceding microelectrode trajectory shift (suggesting such shifts were beneficial). There was no relationship between location error and case order, arguing against a learning effect.<h4>Discussion/conclusion</h4>The proximity of STN-DBS electrodes to a nominated ideal, dorsal STN, stimulation location is highly variable, even when implanted by experienced clinicians with brain shift minimized, and without evidence of a learning effect. Using this measure, we found that assessments on awake patients (microelectrode recordings and clinical examination) likely yielded beneficial intraoperative decisions to improve positioning. In many patients the error is likely to have reduced therapeutic efficacy. More accurate methods to implant STN-DBS electrodes relative to the ideal stimulation location are needed.
format	article
author	Patrick Pearce Kristian Bulluss San San Xu Boaz Kim Marko Milicevic Thushara Perera Wesley Thevathasan
author_facet	Patrick Pearce Kristian Bulluss San San Xu Boaz Kim Marko Milicevic Thushara Perera Wesley Thevathasan
author_sort	Patrick Pearce
title	How accurately are subthalamic nucleus electrodes implanted relative to the ideal stimulation location for Parkinson's disease?
title_short	How accurately are subthalamic nucleus electrodes implanted relative to the ideal stimulation location for Parkinson's disease?
title_full	How accurately are subthalamic nucleus electrodes implanted relative to the ideal stimulation location for Parkinson's disease?
title_fullStr	How accurately are subthalamic nucleus electrodes implanted relative to the ideal stimulation location for Parkinson's disease?
title_full_unstemmed	How accurately are subthalamic nucleus electrodes implanted relative to the ideal stimulation location for Parkinson's disease?
title_sort	how accurately are subthalamic nucleus electrodes implanted relative to the ideal stimulation location for parkinson's disease?
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/a5e2b8d2a8154900996f0da28e817eaf
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How accurately are subthalamic nucleus electrodes implanted relative to the ideal stimulation location for Parkinson's disease?

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