Turkish Neurosurgery
Learning curve in anatomo-electrophysiological correlations in subthalamic nucleus stimulation
Dušan Hrabovský1, Marek Baláž2, Martina Bočková3, Věra Feitová4, Zdeněk Novák1, Jan Chrastina1
1Faculty Hospital St.Ann Brno, Dpt.of Neurosurgery MF MU, Brno,
2Faculty Hospital St.Ann Brno, First Dpt. of Neurology MF MU, Brno,
3Central European Institute of Technology, MU, Brno,
4Faculty Hospital St.Ann Brno, Dpt. of Imaging Techniques MF MU, Brno,
DOI: 10.5137/1019-5149.JTN.19450-16.0

Aim:: Advances in neuroradiological planning techniques in deep brain stimulation put the need for intraoperative electrophysiological monitoring into doubt. Moreover intraoperative monitoring prolongs surgical time and there is potential association between the use of microelectrodes and increased incidence of hemorrhagic complicationsMaterial and Methods:The study analyzes the correlation between the anatomically planned trajectory and the final subthalamic electrode placement after electrophysiological monitoring in patients with Parkinson’s disease and its change with the increasing experience of the surgical team. The trajectories of right (first implanted) and left electrodes were compared in the first 50 patients operated on (Group 1) and the next 50 patients (Group 2). Results:In Group 1, 52% of central trajectories were on the right and 38% on the left; in Group 2, the percentage of central trajectories was 76% on the right and 78% on the left; the difference was statistically significant (p=0.021 and 0.001). The difference in the percentage of posterior trajectories reflecting brain shift between the right and left sides was statistically insignificant in Groups 1 (26% and 28%, p=0.999) and 2 (18% and 12%, p=0.549). The percentage of bilateral central electrodes was 14% and 62% in Groups 1 and 2, respectively. Conclusion:The correlation between anatomically planned trajectory and final electrode placement narkedly improves with the number of patients. However the significant percentage of patients with final electrode trajectory differing from anatomically planned target supports the use of intraoperative monitoring.

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