Half Burr-Hole Method: A Novel Surgical Technique for Reducing Brain Shift and Improving Electrode Placement Accuracy in Deep-Brain Stimulation.

Abstract

Background: Deep-brain stimulation (DBS) is used to treat movement disorders and drug-resistant focal epilepsy. However, electrode placement accuracy is affected by brain shift caused by pneumocephalus and cerebrospinal fluid (CSF) leakage during surgery. We present the novel half burr-hole method for improved DBS electrode placement accuracy.

Case description: This approach was used to treat a 28-year-old man with drug-resistant epilepsy in whom stereo-electroencephalography revealed bilateral seizure onset in the temporal lobes, precluding focal resection. The patient, under general anesthesia, was placed in the supine position. Using a ROSA robot-assisted surgical system, approximately 8-mm-deep "partial burr-holes" were created, with the deeper portion perforated using a 2.4-mm twist drill. Stimulation electrodes were placed bilaterally in the anterior thalamic nucleus. Directional leads were secured using standard burr-hole caps. Postoperative computed tomography confirmed a 0.46-cm ³ pneumocephalus and electrode positioning with 0.47 mm (range: 0-1.62 mm) vector and 0.12 mm (range: 0.08-0.16 mm) axial errors relative to the target coordinates. Postoperative electrode impedance values were within the normal range.

Conclusion: The half burr-hole method effectively minimizes CSF leakage and pneumocephalus during DBS surgery, reducing brain shift and enhancing electrode placement accuracy, and is compatible with standard burr-hole caps for electrode fixation, minimally affecting impedance values.