Objective: Precision in implantation of deep brain stimulation (DBS) electrodes relies on systematic interdisciplinary planning and intra-operative testing and needs to be discussed along with postoperative imaging and clinical long-term follow-up in Parkinson’s disease.

Methods: From 2012 to 2014 we analyzed 45 operations carried out for 44patients (Ø age 59.2, male 28, Ø Hoehn/Yahr St. 2.99) with Parkinson’s disease, among those 5 tremor-dominant, all implanted bilaterally within the STN. STN target and trajectory planning executed on MRI scans was based on anatomical landmarks and on intra-operative micro-recording and test stimulation with primary focus on the posterolateral part of the STN. Analysis evaluated trajectory selection, post-operative imaging control for possible deviation, electrode depth, UPDRS-III, results of the L-Dopa Test, before and at one year follow-up and clinical indications for revision.

Results: 45 DBS implantations (all bilateral) were performed in 44 patients. In 2 patients revision of a unilaterally dislocated electrode was performed 2 days after the primary surgery by re-positioning to the original depth. In 2 patients, due to insufficient clinical response, unilateral new implantation was indicated and carried out in one case successfully, so far. Mean deviation of the final lead position to the planned target point was 0.93mm. UPDRS-III improved on average by 24.5 points (49.9%) pre-operative MedOff vs. StimOn/MedOff. StimOn/MedOff condition matched 84.8% of the presurgical best ON during the levodopa challenge test. 38 patients showed satisfactory motor improvement with regard to disappearance of freezing, continuous mobility and possibility of medication reduction.

Conclusions: UPDRS-III improvement within this patient series is comparable to the average outcome of recent multi-centre studies. StimOn/MedOff conditions achieved results comparable to best medical treatment before surgery which sets the range for possible benefit of STN-DBS. In selected cases with poor response to DBS electrode revision can yield very favourable outcome. In case of unsatisfactory response to DBS, further investigations of the exact electrode position and reassessment of initial diagnosis should be considered.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/dbs-of-the-stn-in-44-patients-with-parkinsons-disease-radiological-and-clinical-outcome/