Objective: To study the accuracy of lead placement and clinical outcome of a novel technique using twist drill hole and smaller incision in Magnetic resonance imaging (MRI) guided DBS procedures

Background: We used a novel technique of smaller incision, minimal shaving and lead anchoring with 1 cm plate to give better cosmetic outcome in comparison to conventional technique of burr hole with cover in MRI guided lead placement and studied its efficacy.

Method: A retrospective observational study carried out from 2022 to 2024. MRI guided DBS procedures for movement disorders were included. Those who lost follow up were excluded.Post operative computerized tomography scan (CT scan) were fused with the pre operative MRI images to calculate the error in lead placement in comparison to target trajectory. Radial error for target trajectory, silicon tube tip and final lead placement was recorded. Clinical outcome was evaluated for Parkinson’s disease patients by Unified Parkinson’s Disease Rating Scale-3 (UPDRS) scores as well as medication reduction. Post operative wound infection, healing and cosmetic satisfaction noted.

Results: Out of 31 patients qualified for study, 21(67.74%) were of Parkinson’s disease (PD). Total 59 leads were implanted (three unilateral). Average length of incision was 2.0 cm and strip of hair around it shaved. We used 3.4 mm twist drill to and anchored leads with 1 cm plate covered in hollow plastic tube to prevent lead damage giving excellent cosmetic outcome. Initial mean target trajectory error for right side was 0.55 mm and left side was 0.51mm. The mean silicone tube tip and final lead position radial error on right side was 0.67±0.33mm (0.1-1.2mm) and 1±0.63mm (0- 1.9mm) (P<0.01) respectively and left side was 0.72+/- 0.35mm (0.2-1.9mm) and 1.14+/- 0.86mm (0-2.7mm) (P<0.01) respectively. Mean UPDRS-3 improved by 68.88% and medication reduced by 52.7% at mean follow up of 14.64 months. The final lead position error, UPDRS-3 improvement and medication reduction were comparable to conventional MRI guided DBS lead placement. One patient (3.22%) had infection.

Conclusion: Minimally invasive MRI guided lead placement for DBS surgeries is safe, equally efficacious and cosmetically superior compared to conventional MRI guided lead placement with burr hole.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/minimally-invasive-magnetic-resonance-imaging-guided-deep-brain-stimulation-for-movement-disorders-a-novel-technique-accuracy-and-clinical-outcome/