Direct localization of subthalamic nucleus supplemented by single-track electrophysiological guidance in deep brain stimulation lead implantation: Techniques and clinical results

Background/Aims: In subthalamic nucleus (STN) deep brain stimulation (DBS) lead implantation, it is still controversial whether it is more appropriate to employ indirect or direct methods in magnetic resonance imaging (MRI)-based tentative targeting and to select single- or multiple-track recording in electrophysiological definitive targeting. The efficacy of single-track electrophysiological recording through direct targeting was compared with the conventional indirect targeting methods in light of the identified STN thickness and clinical results. Methods: The identified mean STN thickness, pre- and 6-month postoperative Unified Parkinson's Disease Rating Scale (UPDRS), dose change of L-dopa and dopaminergic agonists were compared in indirect (midcommissural point-based, 44 procedures) and direct (image-based, 44 procedures) targeting methods. Results: The identified mean STN thickness was significantly greater in the group employing direct methods. For evaluation of the UPDRS, a significant scale improvement was noted in part 2 OFF for both groups. Significant scale improvements occurred in parts 3 and 4 in the group employing the direct method. Both groups revealed significant L-dopa dose reduction with the tendency towards a greater reduction in the group employing the direct method. Conclusion: MRI-based direct targeting supplemented by single-track recording could be justified as a standard for DBS lead implantation to achieve better clinical results.