Objective: To assess deep brain stimulation (DBS) programming outcomes and lead placement after bilateral electrode implantation with unilateral microelectrode mapping.

Background: There is considerable variability in the practice of intraoperative microelectrode recording (MER) during DBS electrode placement. While MER confirms the borders of the target nucleus and helps identify the sensorimotor subregions, it requires longer, awake surgeries and probably increases the risk of intracranial hemorrhage. Our practice is to perform imaging-based stereotactic planning followed by unilateral MER on the initial side to confirm targeting accuracy. The second side is then implanted at the symmetric location, without MER. Effective placement is confirmed intraoperatively with macrostimulation testing bilaterally.

Methods: We retrospectively reviewed all cases of deep brain stimulator electrode placement for Parkinson’s disease performed at our center by a single surgeon (E.E.) between 2007 and 2014 (n = 135 cases). In 103 cases (53 STN, 50 GPi), bilateral electrode implantation was performed with unilateral MER. We reviewed the DBS programming outcomes of the 73 cases (37 STN, 36 GPi) followed longitudinally at our center. DBS electrodes were identified on postoperative CT imaging fused to preoperative MRI and normalized to MNI space for group-level comparisons relative to target structures derived from a 7T MRI basal ganglia atlas (ATAG).

Results: Comparing the microelectrode mapped vs. unmapped hemisphere, as previously reported we observed no difference in DBS voltage, pulse width, likelihood of non-monopolar stimulation, or distribution of active contacts and no difference in the number of programming adjustments required to reach stable stimulator settings. Electrode proximity to the presumptive optimal anatomical target in the posterior-dorsal STN or posterior-ventral GPi did not differ between mapped and unmapped hemispheres, nor did the variance of spatial location (i.e., scatter) of electrode contacts.

Conclusions: These results suggest that careful imaging-based targeting paired with unilateral microelectrode mapping can achieve safe, accurate and effective DBS electrode implantation. Limitations of this study include the retrospective design and absence of detailed DBS motor outcomes which were not available in our database.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/unilateral-microelectrode-mapping-to-guide-bilateral-deep-brain-stimulation-electrode-implantation-a-retrospective-study-of-anatomical-lead-placement-and-dbs-programming-outcomes/