Accuracy of Placement of Deep Brain Stimulation Leads May be Better with a Staged Approach

Congratulations Drs. Deeb, Almeida, Foote an Okun on the publication of “Accuracy of Placement of Deep Brain Stimulation Leads May be Better with a Staged Approach“, which was published in the April 27th edition of Neurology.

ABSTRACT

Objective: To evaluate differences in lead location between simultaneous versus staged implantation of bilateral deep brain stimulation (DBS) electrodes.

Background: Appropriate pre-DBS evaluation relies on an inter-disciplinary approach to sort out eligibility, target decision, and determination of unilateral versus bilateral lead implantation. There is, however, no guideline to determine simultaneous implantation of bilateral leads versus performing two separate surgeries which may be weeks to months apart (staged).

Design/Methods: A retrospective single-center study was conducted. Lead locations were calculated for DBS implantation into the subthalamic nucleus (STN), globus pallidus internus (GPi), or the ventralis intermedius nucleus of thalamus (VIM) from 2002 to April 2016. Patients with lead revisions or experimental targets were excluded. Lead error was defined as the linear distance between pre-operative planned placement and final lead location based on the post-operative lead measurement. Analysis of covariance (ANCOVA) was conducted to compare error differences across subgroups, correcting for potential confounders, assuming a p<0.05 for statistical significance.

Results: The analysis included 604 patients (33.1% female) and 58.8% had unilateral leads, 35.8% bilateral staged leads, and 5.5% bilateral simultaneous leads. Mean age was 67.53±13.97 years. The simultaneously implanted DBS group was significantly younger (mean age 44.82 years). Among 853 leads there was 36.9% in STN, 38.7% in GPi and 24.3% in VIM. After correction for age, simultaneous lead implantation was associated with greater error compared to the staged approach (2.96±1.99mm and 2.20±1.42mm respectively, p=0.008). Subsequent analysis by individual targets replicated the findings in both GPi and STN targets.

Conclusions: These results indicate that a staged approach to bilateral DBS lead could be associated with a lower lead placement error, potentially contributing to lower rates of lead revisions and reduced morbidity. Further studies with a larger prospective randomized design will be needed to confirm or refute these findings.