{"title":"A single centre experience of asleep, robotic, intraoperative image-guided, single-stage deep brain stimulation (DBS) surgery for movement disorders.","authors":"Ming-Sheng Lim, Annamma Mathew, Federica Ruggieri, Eoghan Donlon, Richard Walsh, Catherine Moran","doi":"10.1080/02688697.2025.2560422","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>Deep brain stimulation (DBS) is an established treatment for movement disorders. However, there remains a wide variation in practice of surgical technique, such as the use of a stereotactic frame, robotic guidance, awake or asleep surgery, intraoperative imaging, and microelectrode recording (MER).</p><p><strong>Research question: </strong>This report aims to share the surgical workflow and outcomes of the first 50 patients undergoing DBS at our institution.</p><p><strong>Material and methods: </strong>This is a retrospective descriptive study including all patients who underwent DBS for movement disorders from November 2021 until November 2024. A description of the perioperative and intraoperative workflow is given. Patient demographics, pathology, surgical targets, and implant brands used are reported. Outcome measures including robotic registration accuracy, frequency of lead placement error requiring lead adjustment, complications, degree of symptom improvement following programming sessions, and neuropsychiatric and quality of life outcomes are reported.</p><p><strong>Results: </strong>50 consecutive patients were included in this study. 62% had a diagnosis of Parkinson's disease (PD), 28% dystonia, and 10% essential tremor (ET). 30% of patients required intraoperative adjustments to their lead placement, with 47% of these adjustments requiring adjustment to the trajectory. Patients with Globus Pallidus internus (GPi) targets had a higher odds of requiring an intraoperative adjustment to electrode depth, possibly to avoid the visual side effects from stimulation of the optic tracts. All patients had symptomatic improvement, and most patients with PD had improvements in mood and quality of life following DBS. 9 patients with PD had transient delirium post operatively, and 11 had small reductions in cognition at 6 months follow up that correlated with advanced age. There were no haemorrhagic complications, one patient required a reoperation for infection, and one patient required a reoperation due to late lead migration.</p><p><strong>Discussion and conclusion: </strong>DBS surgery employing our workflow is safe, effective, and versatile.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"1-11"},"PeriodicalIF":0.8000,"publicationDate":"2025-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"British Journal of Neurosurgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1080/02688697.2025.2560422","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Introduction: Deep brain stimulation (DBS) is an established treatment for movement disorders. However, there remains a wide variation in practice of surgical technique, such as the use of a stereotactic frame, robotic guidance, awake or asleep surgery, intraoperative imaging, and microelectrode recording (MER).
Research question: This report aims to share the surgical workflow and outcomes of the first 50 patients undergoing DBS at our institution.
Material and methods: This is a retrospective descriptive study including all patients who underwent DBS for movement disorders from November 2021 until November 2024. A description of the perioperative and intraoperative workflow is given. Patient demographics, pathology, surgical targets, and implant brands used are reported. Outcome measures including robotic registration accuracy, frequency of lead placement error requiring lead adjustment, complications, degree of symptom improvement following programming sessions, and neuropsychiatric and quality of life outcomes are reported.
Results: 50 consecutive patients were included in this study. 62% had a diagnosis of Parkinson's disease (PD), 28% dystonia, and 10% essential tremor (ET). 30% of patients required intraoperative adjustments to their lead placement, with 47% of these adjustments requiring adjustment to the trajectory. Patients with Globus Pallidus internus (GPi) targets had a higher odds of requiring an intraoperative adjustment to electrode depth, possibly to avoid the visual side effects from stimulation of the optic tracts. All patients had symptomatic improvement, and most patients with PD had improvements in mood and quality of life following DBS. 9 patients with PD had transient delirium post operatively, and 11 had small reductions in cognition at 6 months follow up that correlated with advanced age. There were no haemorrhagic complications, one patient required a reoperation for infection, and one patient required a reoperation due to late lead migration.
Discussion and conclusion: DBS surgery employing our workflow is safe, effective, and versatile.
期刊介绍：
The British Journal of Neurosurgery is a leading international forum for debate in the field of neurosurgery, publishing original peer-reviewed articles of the highest quality, along with comment and correspondence on all topics of current interest to neurosurgeons worldwide.
Coverage includes all aspects of case assessment and surgical practice, as well as wide-ranging research, with an emphasis on clinical rather than experimental material. Special emphasis is placed on postgraduate education with review articles on basic neurosciences and on the theory behind advances in techniques, investigation and clinical management. All papers are submitted to rigorous and independent peer-review, ensuring the journal’s wide citation and its appearance in the major abstracting and indexing services.
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