Stereotactic and Functional Neurosurgery最新文献

{"title":"Is It Safe to Have Deep Brain Stimulation after MRI-Guided Focused Ultrasound Ablation? A Report of Three Cases and Review of Literature.","authors":"Jason Yuen, Hassan Khayat, Fatima A Fakhroo, Rafael Buongermini, Jurgen Germann, Alexandre Boutet, Alfonso Fasano, Andres M Lozano","doi":"10.1159/000551355","DOIUrl":"10.1159/000551355","url":null,"abstract":"<p><strong>Introduction: </strong>MRI-guided focused ultrasound (MRgFUS) ablation has become increasingly utilised for movement disorders since its approval by the US Food and Drug Administration (FDA) in the treatment of unilateral essential tremor (ET) in 2016. While most patients achieve significant improvement in their symptoms, a proportion of ET patients experience tremor recurrence. Deep brain stimulation (DBS) is a potential rescue therapy post-MRgFUS. However, the safety profile of such scenarios is currently unknown.</p><p><strong>Case presentations: </strong>Here, we report 3 ET patients who previously underwent MRgFUS of the ventral intermediate nucleus of the thalamus (Vim) and subsequently had DBS insertion due to tremor recurrence. Three patients (ranging from 58 to 85 years of age; one female) presented with a history of refractory ET. Patient 1 had left Vim MRgFUS and then left Vim DBS. However, the tremor control was still inadequate, and he had a further revision DBS surgery where two electrodes were inserted into left Vim. Patient 2 had two MRgFUS procedures in left Vim and then underwent left Vim DBS insertion due to hand tremor recurrence. Patient 3 had left Vim MRgFUS and then bilateral Vim DBS due to midline tremor. Patients 2 and 3 experienced substantial improvement in symptoms after DBS, but patient 1 only had minimal improvement. There were no surgical complications and no readmission within 30 days.</p><p><strong>Conclusions: </strong>This case series demonstrates that insertion of DBS electrodes in the vicinity of prior MRgFUS site can be safe. These findings have important implications for pre-operative counselling of patients with ET with high surgical risks, as well as supporting MRgFUS as a first-line therapy in selected patients. Further studies with larger population will delineate the optimal timeline where DBS may be safely performed in this population, as well as the long-term therapeutic effect of such rescue intervention.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"1-9"},"PeriodicalIF":2.1,"publicationDate":"2026-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13155732/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147370445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Initial Clinical Experience with the First FDA-Approved sEEG-Guided Radiofrequency Ablation System Featuring Real-Time Temperature Monitoring: A Case Series.","authors":"Baltazar Zavala, Efstathios Kondylis, Juan Bulacio, Jason Chisholm, Stephen Harasimchuk, Richard Rammo, William Bingaman, Demitre Serletis","doi":"10.1159/000551390","DOIUrl":"10.1159/000551390","url":null,"abstract":"<p><strong>Introduction: </strong>Stereoelectroencephalography-guided radiofrequency ablation (sEEG-RFA) has been used to create stereotactic lesions in epileptic networks. The method has been applied as a diagnostic (and at times, palliative) intervention, primarily in European epilepsy programs. To date, the technique has not been widely popularized in the USA given the lack of FDA-approved technology permitting safe usage of in situ sEEG electrodes for this purpose. Recently, the FDA approved a new hollow sEEG electrode and OneRF generator (NeuroOne) featuring real-time thermal monitoring.</p><p><strong>Case presentations: </strong>The authors present four illustrative, consecutive cases of refractory epilepsy patients undergoing sEEG, who underwent subsequent sEEG-RFA using the new technology. The procedure was diagnostic in all cases, with no adverse events. Importantly, all 4 patients reported decreased seizure burden following the procedure, with observed improvements informing subsequent surgical decision-making in 3 patients.</p><p><strong>Conclusion: </strong>A new FDA-approved, hollow sEEG electrode technology permits safe sEEG-RFA lesioning, with a positive experience for both the patient and clinical team. The authors reaffirm use of this strategic technique as a diagnostic and prognostic tool, with possibility of secondary therapeutic, ablative effects. This development represents a significant advancement in the work-up of patients with intractable epilepsy, who are undergoing sEEG for invasive evaluation.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"1-8"},"PeriodicalIF":2.1,"publicationDate":"2026-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13155735/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147365853","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postoperative Weight Gain and Body Composition in DBS Patients: Associations with IPG Recharge Efficiency.","authors":"Clodagh O Apos Keeffe, Federica Ruggieri, Eoghan Donlon, Annamma Mathew, John Inocentes, Conor Fearon, Timothy Lynch, Catherine Moran, Richard A Walsh","doi":"10.1159/000551249","DOIUrl":"10.1159/000551249","url":null,"abstract":"<p><strong>Introduction: </strong>Deep brain stimulation (DBS) has become an increasingly common therapeutic intervention for the management of movement disorders. In addition, weight gain has been reported following DBS implantation. Several case reports and anecdotal experiences raise questions of difficulties in recharging batteries in patients with larger body mass; however, the relationship between body mass and charge times has not been systematically investigated.</p><p><strong>Methods: </strong>In this exploratory cross-sectional study, 30 people with DBS underwent a standardized charging protocol to establish the rate of battery charge acquisition. Biometric data, including weight, BMI, and body fat, were recorded to establish relationships between biometric parameters and charge rate.</p><p><strong>Results: </strong>In total, 75% of participants had gained weight since the DBS implantation, with male and female participants gaining, on average, 6.7 kg. A strong and statistically significant correlation was found between body fat and the rate of charge of IPG of male participants (r = -0.6, p = 0.02), but not for female participants, despite having a greater degree of body fat (p < 0.01).</p><p><strong>Conclusion: </strong>Increases in body mass increase the depth of adipose tissue that lies between the implantable pulse generator and the charger, possibly creating greater resistance for the charge to pass through, hence increasing charge time. These findings inform postoperative educational content regarding the importance of maintaining weight following DBS implantation and reduce the need for additional corrective surgeries in future. Further evaluation of the absence of a significant finding in females is required.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"1-6"},"PeriodicalIF":2.4,"publicationDate":"2026-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147356602","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Hospital Volume Status on Postoperative Outcomes and Cost following Deep Brain Stimulation for Movement Disorders.","authors":"Stefan T Prvulovic, Omar Sbaih, Michael M Covell, Ryan Gensler, Shubhang Bhalla, Andre A Payman, Tyler Zeoli, Joanna M Roy, Christian A Bowers","doi":"10.1159/000551148","DOIUrl":"10.1159/000551148","url":null,"abstract":"<p><strong>Introduction: </strong>Deep brain stimulation (DBS) has emerged as a transformative neurosurgical intervention for refractory movement disorders, including Parkinson's disease (PD), essential tremor (ET), and dystonia. While clinical efficacy is well established, significant variability exists in procedural outcomes across hospitals. This nationwide study investigated the impact of hospital procedural volume on short-term postoperative outcomes and cost following DBS across 234 US hospitals from 2015 to 2020.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of 6,964 DBS procedures (2015-2020) using the Nationwide Inpatient Sample. Hospitals were categorized by 6-year DBS volume: high-volume centers (HVCs, ≥450), medium-volume (50-449), and low-volume (<50). Multivariable regression assessed outcomes, including prolonged length of stay (pLOS >75th percentile), nonroutine discharge (NRD), high charge (>90th percentile), and complications, controlling for patient demographics, comorbidities, and hospital characteristics.</p><p><strong>Results: </strong>HVCs showed superior outcomes compared with low-volume centers, with lower rates of pLOS (4.1% vs. 8.9%, p < 0.001), high charges (6.7% vs. 15.3%, p < 0.001), and NRD (11.0% vs. 16.5%, p < 0.001). PD patients had 45% greater odds of pLOS (OR = 1.45, 95% CI: 1.12-1.88, p = 0.004) but 36% lower odds of NRD (OR = 0.64, 95% CI: 0.49-0.83, p = 0.001) compared with ET patients. Dystonia patients had 2.4 times higher odds of pLOS (OR = 2.39, 95% CI: 1.76-3.25, p < 0.001) and 65% higher odds of incurring high charges (OR = 1.65, 95% CI: 1.22-2.23, p = 0.001). In multivariate models, HVCs were significantly associated with reduced risk of NRD, high charge, and pLOS.</p><p><strong>Conclusion: </strong>Despite a 6% decline in DBS volume due to fewer PD cases, inflation-adjusted charges rose >30% across centers. The volume-outcome relationship persists, with HVCs showing better efficiency but challenges in discharge disposition, highlighting the need for standardized care pathways for dystonia and closer evaluation of socioeconomic barriers to DBS access and outcomes.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"1-15"},"PeriodicalIF":2.4,"publicationDate":"2026-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147344892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ventriculomegaly and Brain Atrophy in Deep Brain Stimulation: A Literature Review of Technical Challenges, Prognostic Implications, and Surgical Risks.","authors":"José Armando Díaz-Martínez, Juan Camilo Covaleda-Rodríguez, Juan Manuel Altamirano, Francisco Alejandro Luna-Rangel, Daniel Martinez-Ramirez","doi":"10.1159/000551150","DOIUrl":"10.1159/000551150","url":null,"abstract":"<p><strong>Background: </strong>Deep brain stimulation (DBS) is a cornerstone treatment for medically refractory movement disorders. Ventriculomegaly and brain atrophy, common findings in candidates for DBS, present technical challenges, prognostic dilemmas, and potential safety concerns. Their impact on clinical outcomes and procedural risk remains a subject of debate. This review aims to synthesize the literature on the relationship between preoperative ventriculomegaly and brain atrophy, as surrogates for subcortical and cortical neurodegeneration, and their impact on motor outcomes, safety, and surgical complications of DBS.</p><p><strong>Summary: </strong>A narrative review of the literature was conducted using PubMed database to identify articles addressing the relationship between ventriculomegaly, brain atrophy, and DBS outcomes in movement disorders. Multiple cohort studies demonstrate a significant correlation between larger preoperative ventricular volumes, cortical atrophy, and subcortical volume loss with poorer motor improvement following DBS, suggesting these morphometric changes are markers of underlying neurodegenerative burden. Critically, direct evidence shows that transgressing the ventricular wall during STN DBS surgery significantly increases the risk of postoperative confusion (relative risk = 87; 95% CI: 12.3-615.2; p < 0.001). While the overall risk of severe complications like symptomatic hemorrhage remains low (approximately 1.1%), factors such as patient comorbidities, surgical technique, and postoperative electrode displacement are key contributors to adverse outcomes. Nevertheless, case reports confirm that excellent outcomes are achievable in patients with marked ventriculomegaly and brain atrophy, provided that meticulous surgical planning is employed.</p><p><strong>Key messages: </strong>Preoperative ventriculomegaly and brain atrophy are negative prognostic indicators for motor outcomes and direct risk factors for neurological sequelae, particularly postoperative confusion. However, they should not be absolute contraindications to DBS. With modern neuronavigation, careful trajectory planning, and a strong clinical rationale, the risks can be mitigated and favorable outcomes achieved. Importantly, patients may derive significant quality of life benefits even with modest motor improvements. This review provides an evidence-based framework to guide clinical judgment and surgical strategy in this challenging patient population.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"1-11"},"PeriodicalIF":2.4,"publicationDate":"2026-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147318186","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Deep Brain Stimulation for Intractable Hiccups due to Diaphragmatic Dystonia: A First Reported Case.","authors":"Marcin Rudaś, Damian Palus, Magdalena Jabłońska, Oskar Puk, Paweł Klemens Sokal","doi":"10.1159/000551173","DOIUrl":"10.1159/000551173","url":null,"abstract":"<p><strong>Introduction: </strong>Chronic hiccups (singultus) are involuntary diaphragmatic contractions that, when persistent, can cause severe physical and psychological distress. While most cases are benign and self-limited, intractable hiccups may rarely indicate underlying neurological dysfunction. One exceptionally rare cause is diaphragmatic dystonia - a condition for which no established diagnostic criteria or treatment guidelines exist, and which has been described only in isolated case reports.</p><p><strong>Case presentation: </strong>We present the first known case of deep brain stimulation (DBS) of the internal and external globus pallidus (GPi and GPe) used to treat chronic, treatment-resistant hiccups. A 70-year-old woman experienced 2 years of continuous hiccups unresponsive to multiple pharmacologic and surgical interventions. Extensive diagnostics excluded metabolic, neurological, gastrointestinal, and psychiatric causes. Diaphragmatic dystonia was suspected. Bilateral octa-contact DBS electrodes were implanted targeting the GPi and GPe. Intraoperative monopolar stimulation (1.5 mA, 90 µs, 130 Hz) was initiated on day of surgery. Electrodes were accurately placed without complications.</p><p><strong>Results: </strong>Near-complete resolution of hiccups occurred immediately postoperatively. Quality of life significantly improved: Numerical Rating Scale (NRS) from 8 to 0, EQ-5D-3L from 0.530 to 1.0, Fahn-Marsden Dystonia Scale from 13 to 0, and PHQ-9 from 16 to 4. At the 14-month follow-up, the improvement was fully maintained.</p><p><strong>Conclusion: </strong>DBS targeting the globus pallidus may represent a novel and effective intervention for refractory chronic hiccups, particularly in cases suspected to involve diaphragmatic dystonia.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"1-6"},"PeriodicalIF":2.4,"publicationDate":"2026-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147310338","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cosmetic-Oriented Deep Brain Stimulation: A No-Shave Cranial and Trans-Axillary Fossa Implantable Pulse Generator Implantation Technique.","authors":"Takahiro Ueno, Kilsoo Kim, Masato Murakami, Takakazu Kawamata, Takaomi Taira, Shiro Horisawa","doi":"10.1159/000551075","DOIUrl":"10.1159/000551075","url":null,"abstract":"<p><strong>Introduction: </strong>Deep brain stimulation (DBS) is an established therapy for movement disorders. However, conventional DBS often involves complete scalp shaving and a visible subclavicular incision for implantable pulse generator (IPG) placement, which may cause cosmetic and psychological burden, particularly in younger or female patients. To address these issues, we developed a cosmetic-oriented DBS technique combining a no-shave cranial approach with trans-axillary fossa IPG implantation.</p><p><strong>Methods: </strong>In this single-center retrospective series, we analyzed 60 consecutive patients who underwent DBS implantation using a no-shave cranial approach with trans-axillary fossa IPG placement. Procedural characteristics and postoperative complications were reviewed retrospectively.</p><p><strong>Results: </strong>Sixty patients underwent DBS implantation with this cosmetic-oriented protocol. The mean age at surgery was 50.4 ± 14.7 years, and the mean follow-up was 31.6 ± 18.3 months. The mean operative time, including IPG placement, was 159.1 ± 64.4 min (range 70-353). Early postoperative infection occurred in 2 patients (3.3%), both confined to the axillary IPG pocket within 1 month; no cranial infections or hematomas were observed. Non-infectious complications occurred in 3 patients (5.0%) (one cervical extension foreign-body reaction, one cranial insertion-site reaction, and one lateral IPG displacement requiring revision). Mild transient axillary tightness was reported in 10 patients (16.7%) and resolved without intervention.</p><p><strong>Conclusion: </strong>This cosmetic-oriented DBS method demonstrated a low infection rate and consistent concealment of cranial and axillary incisions, with no apparent signal of increased risk in this series. The approach appears technically feasible across different ages and in both sexes, although patient satisfaction was not formally evaluated.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"1-8"},"PeriodicalIF":2.4,"publicationDate":"2026-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146259236","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Denial of Hardware-Related Skin Erosion in Patients with Effective Deep Brain Stimulation: A Novel Phenomenon.","authors":"Filipe Wolff Fernandes, Rasmus Stenmark Persson, Assel Saryyeva, Joachim Runge, Patric Blomstedt, Joachim K Krauss","doi":"10.1159/000550653","DOIUrl":"10.1159/000550653","url":null,"abstract":"<p><strong>Introduction: </strong>Deep brain stimulation (DBS) is an established therapy that can significantly improve patients' quality of life in several disorders. Besides its benefits, hardware-related problems including erosion and wound infections are well known problems. In the present series, we describe a novel phenomenon manifesting as denial for hardware-related skin erosion in patients with movement disorders benefiting from DBS in various targets.</p><p><strong>Methods: </strong>Patients were collected from two large DBS cohorts over a period of 28 years. The skin erosion was identified upon the occasion of a routine follow-up with the patients apparently being unaware/not noticing its occurrence. Demographic, clinical, and operative data were analyzed. Additionally, the hardware-related skin erosion and its time of diagnosis, as well as the consecutive treatment, were registered.</p><p><strong>Results: </strong>Overall, 5 patients were identified with denial for hardware-related skin erosion. Three were men; two were women. The mean age at surgery was 66 years (range, 54-78). Three patients had dystonia; 2 patients had Parkinson's disease. DBS targets were the globus pallidus internus and various thalamic nuclei. All patients benefited markedly from chronic DBS (mean improvement of 76.7% according to the specific rating scales). The hardware-related skin erosion was diagnosed at a median follow-up of 18 months after DBS implantation (range, 5-264 months). Despite multiple surgical attempts at preservation, the neurostimulation system was ultimately explanted in 3 patients.</p><p><strong>Conclusion: </strong>Denial toward hardware-related skin erosion in DBS, most probably denial, is a rare but potentially serious complication during chronic DBS.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"1-7"},"PeriodicalIF":2.1,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13038234/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146087380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative Brain Atrophy as a Predictor of Motor Outcomes after Subthalamic Nucleus Deep Brain Stimulation in Parkinson's Disease.","authors":"Rafał Wójcik, Agata Gajos, Anna Dębska, Karol Zaczkowski, Małgorzata Podstawka, Bartosz Szmyd, Ernest J Bobeff, Michael Gregory Brandel, Andreas Fahlström, Paweł Ratajczyk, Dariusz Jan Jaskólski, Karol Wiśniewski","doi":"10.1159/000549635","DOIUrl":"10.1159/000549635","url":null,"abstract":"<p><strong>Introduction: </strong>Brain atrophy is common in Parkinson's disease (PD) and contributes to motor and cognitive decline. However, the predictive value of neuroimaging-based volumetric measures for motor outcomes following deep brain stimulation (DBS) remains unclear. Notably, subclinical dementia may play a key role in DBS response. This study examines whether preoperative volumetric assessment can predict motor outcomes after subthalamic nucleus (STN) DBS in PD.</p><p><strong>Methods: </strong>Preoperative T1-weighted 3D MP-RAGE magnetic resonance images scans were analyzed to measure subcortical, ventricular, and cortical volumes using Brainlab software. Motor outcomes were assessed by changes in the Movement Disorder Society - Unified Parkinson's Disease Rating Scale part III (MDS-UPDRS-III) scores pre- and postoperatively in 39 participants. Stepwise logistic regression was performed to determine associations between brain volumes and DBS response.</p><p><strong>Results: </strong>Smaller substantia nigra compacta volume {0.81 (interquartile range [IQR]: 0.74-0.85) vs. 0.72 [IQR: 0.69-0.73]), larger ventricular system (26.1 [IQR: 21.4-30.05] vs. 34.1 [IQR: 28.6-40.87]), and lower atrophy ratio (41.76 [IQR: 37.59-50.71] vs. 29.63 [IQR: 25.9-36.55]) were significantly associated with reduced motor improvement following STN-DBS. The predictive model based on these values demonstrated excellent performance (area under the receiver operating characteristic curve = 0.95, 95% CI: 0.87-1; p < 0.01) in forecasting poorer DBS treatment outcomes as measured by the MDS-UPDRS-III scale. Additionally, lower thalamic volume and poorer executive function (assessed by the Frontal Assessment Battery) correlated positively with a lower atrophy ratio.</p><p><strong>Conclusion: </strong>Our findings highlight the impact of enlargement of ventricular system and brain atrophy, particularly of the substantia nigra, on motor outcomes after STN-DBS. The association between atrophy measures and executive dysfunction suggests that subclinical dementia may underlie poor DBS response. Brain atrophy could serve as an early marker of cognitive decline, influencing postoperative disease progression and treatment outcomes. Future studies should further explore the role of neurodegeneration in DBS response to optimize patient selection and electrode targeting.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"1-13"},"PeriodicalIF":2.4,"publicationDate":"2026-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146041703","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-Term Mortality and 10-Year Outcomes after Subthalamic Nucleus Deep Brain Stimulation in Parkinson's Disease.","authors":"Hikaru Kamo, Genko Oyama, Mai Shimizu, Masanobu Ito, Hirokazu Iwamuro, Atsushi Umemura, Taku Hatano, Nobutaka Hattori","doi":"10.1159/000550490","DOIUrl":"10.1159/000550490","url":null,"abstract":"<p><strong>Introduction: </strong>Subthalamic nucleus deep brain stimulation (STN-DBS) effectively improves motor symptoms in Parkinson's disease (PD), but long-term survival outcomes and mortality predictors remain unclear. This study aimed to evaluate survival and 10-year clinical outcomes after STN-DBS.</p><p><strong>Methods: </strong>We retrospectively analyzed 608 patients with PD who underwent bilateral STN-DBS between 2006 and 2023. Kaplan-Meier and Cox regression analyses assessed survival and preoperative predictors. Motor (Movement Disorder Society Unified Parkinson's Disease Rating Scale [MDS-UPDRS Part III]), cognitive (Montreal Cognitive Assessment [MoCA], Mini-Mental State Examination), and medication (levodopa equivalent daily dose [LEDD]) data were compared between baseline and 10 years postoperatively.</p><p><strong>Results: </strong>During a mean follow-up of 4.8 ± 3.5 years, 42 deaths (6.9%) occurred, yielding an age-adjusted mortality rate of 3.3 per 100,000 person-years. The estimated 5- and 10-year survival rates were 95% and 77%, respectively. The most frequent cause of death was aspiration pneumonia (11.9%). In multivariate Cox analysis, lower preoperative MoCA scores (hazard ratio [HR] = 0.83, 95% CI 0.73-0.95, p < 0.01) and higher OFF state MDS-UPDRS Part III scores (HR = 1.03, 95% CI 1.00-1.07, p < 0.05) independently predicted mortality, whereas age at surgery was not significantly associated with survival. Among 118 patients with 10-year follow-up, OFF state motor and cognitive scores worsened significantly (p < 0.01), while ON state motor scores (p = 0.21) and total LEDD (p = 0.06) remained stable, suggesting sustained motor control and medication-sparing effects.</p><p><strong>Conclusion: </strong>Long-term survival after STN-DBS in PD was favorable. Preoperative cognitive and motor status, rather than age, determined long-term prognosis, emphasizing the enduring therapeutic value of STN-DBS.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"1-11"},"PeriodicalIF":2.1,"publicationDate":"2026-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12959889/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146004184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}