Objective: The objective of this study was to evaluate the frequency of intraoperative adjustment of lead placement in patients undergoing awake subthalamic nucleus (STN) DBS surgery for PD, and to compare the outcome of patients who needed adjustment of lead placement with that of patients whose anticipated placement pre-operatively matched the verified target.

Background: Deep brain stimulation (DBS) surgery is effective in patients with Parkinson’s disease (PD) with refractory tremor or levodopa induced complications. Accurate lead placement and patient selection remain pivotal for successful outcome. In DBS, awake surgery is the standard of care using pre-operative MRI combined with intraoperative neurophysiological verification. Recently, intraoperative MRI target verification during asleep surgery became available, possibly with fewer complications and shorter surgical time^1,2.

Method: All patients who had awake DBS were identified retrospectively from our records from 2016-2020 and separated into two cohorts based on whether their preoperatively determined target matched their intraoperatively verified target (“bicentral true” (BT)) or whether one/both leads had to be adjusted intraoperatively (“bicentral false” (BF)). The outcome was assessed by comparison of the pre-operative and 6-month post-operative best treatment-on UPDRS-3 and levodopa equivalent daily dose in each group. The number of adjustments to optimize treatment was also determined and compared.

Results: 65 patients were identified; in 28% at least one lead was moved after intraoperative testing. 36 patients, 18 in each group and age and gender matched, were randomly included for analysis. There was no significant difference between the outcome of patients with BT and BF; mean UPDRS-3 reduction of 22.2 and 23.9 (p=0.48) and LLED reduction of 80.2% and 76.7% (p=0.05) was found in the BT vs the BF groups respectively. The BF group required fewer follow-up visits in the 6-month follow-up time, possibly indicating a trend towards more accurate physiological placement.

Conclusion: A large proportion of patients needed intraoperative adjustment of lead placement. Outcome between groups who needed adjustment vs those who did not, was similar. Awake surgery offers the advantage of achieving more accurate placement of electrodes in patients undergoing DBS surgery in PD.

References: 1. Warnke P. Deep brain stimulation: awake or asleep: it comes with a price either way. J Neurol Neurosurg Psychiatry. 2018;89(7):672. doi:10.1136/jnnp-2017-315710 2. Engelhardt J, Caire F, Damon-Perrière N, et al. A Phase 2 Randomized Trial of Asleep versus Awake Subthalamic Nucleus Deep Brain Stimulation for Parkinson’s Disease. Stereotact Funct Neurosurg. 2020;33076. doi:10.1159/000511424

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MDS Abstracts - https://www.mdsabstracts.org/abstract/frequency-and-outcome-of-intraoperative-lead-adjustment-in-awake-deep-brain-stimulation-surgery-in-parkinsons-disease/