Refining Stereotaxic Deep Brain Stimulation Surgery Procedures for Parkinson Disease in Pursuit of Zero Pneumocephalus: 2-Dimensional Operative Video.

Abstract

Background and objectives: Deep brain stimulation (DBS) is a well-established intervention for alleviating both motor and nonmotor symptoms of Parkinson disease. However, a common complication of stereotaxic DBS surgery is pneumocephalus, which can compromise electrode accuracy, complicate postoperative assessments, and negatively affect the long-term outcomes of DBS surgery. This report proposes a comprehensive and robust set of recommendations aimed at optimizing DBS surgical protocols to achieve zero pneumocephalus outcomes.

Methods: A retrospective analysis was undertaken on 138 patients with Parkinson disease who underwent simultaneous bilateral stereotaxic DBS targeting either the subthalamic nucleus or the globus pallidus internus at a single institution. The study compared the pneumocephalus volume and postsurgical electrode tip displacement between the original surgical technique and a refined procedure that incorporated modified supine position, dural puncture, and liquid sealing.

Results: With the implementation of the refined procedure, the volume of pneumocephalus significantly decreased from 14.40 ± 17.00 to 0.32 ± 1.02 mL, with 92.9% of patients showing no visible pneumocephalus or intracranial air less than 1 mL. In addition, the refined procedure was associated with less electrode tip displacement in the postoperative stage.

Conclusion: The refined procedure effectively minimized the average pneumocephalus volume to approximately 0, and bilateral DBS electrodes exhibited enhanced stability during the postoperative stage.