BACKGROUND: Image-guided neuronavigation has largely replaced stereotactic frames when precise, real-time anatomic localization is required during neurosurgical procedures. However, some procedures, including placement of deep-brain stimulation (DBS) leads for the treatment of movement disorders, are still performed using frame-based stereotaxy. Despite the demonstration of comparable accuracy between frame-based and "frameless" image-guided approaches, the clinical efficacy of frameless DBS placement has never been reported. OBJECTIVE: To analyze the outcomes of subthalamic nucleus (STN) DBS using the frameless technique for the treatment of Parkinson's disease (PD). METHODS: Of 31 subjects (20 men) with PD for 10 ± 4 years, 28 had bilateral STN DBS and 3 had unilateral STN DBS. The Unified Parkinson's Disease Rating Scale (UPDRS) motor scale (III) and total medication doses were assessed before surgery on and off medication and off medication/ON DBS (off/ON) after 6 to 12 months of STN DBS. RESULTS: There was a 58% improvement from bilateral STN DBS in the UPDRS III (40 ± 16 preoperatively off, 17 ± 11 off/ON) 9.6 ± 1.9 months after surgery (P < .001). This compared favorably with the published outcomes using the frame-based technique. All motor subscores improved significantly (P < .01). The mean reduction in medication was 50%. No intraoperative complications occurred, but one subject with hypertension died of a delayed hemorrhage postoperatively. Two subjects developed postoperative infections that required lead removal and antibiotics. CONCLUSIONS: Bilateral STN DBS for PD performed by an experienced team using a frameless approach results in outcomes comparable to those reported with the use of the frame-based technique.
BACKGROUND: Image-guided neuronavigation has largely replaced stereotactic frames when precise, real-time anatomic localization is required during neurosurgical procedures. However, some procedures, including placement of deep-brain stimulation (DBS) leads for the treatment of movement disorders, are still performed using frame-based stereotaxy. Despite the demonstration of comparable accuracy between frame-based and "frameless" image-guided approaches, the clinical efficacy of frameless DBS placement has never been reported. OBJECTIVE: To analyze the outcomes of subthalamic nucleus (STN) DBS using the frameless technique for the treatment of Parkinson's disease (PD). METHODS: Of 31 subjects (20 men) with PD for 10 ± 4 years, 28 had bilateral STN DBS and 3 had unilateral STN DBS. The Unified Parkinson's Disease Rating Scale (UPDRS) motor scale (III) and total medication doses were assessed before surgery on and off medication and off medication/ON DBS (off/ON) after 6 to 12 months of STN DBS. RESULTS: There was a 58% improvement from bilateral STN DBS in the UPDRS III (40 ± 16 preoperatively off, 17 ± 11 off/ON) 9.6 ± 1.9 months after surgery (P < .001). This compared favorably with the published outcomes using the frame-based technique. All motor subscores improved significantly (P < .01). The mean reduction in medication was 50%. No intraoperative complications occurred, but one subject with hypertension died of a delayed hemorrhage postoperatively. Two subjects developed postoperative infections that required lead removal and antibiotics. CONCLUSIONS: Bilateral STN DBS for PD performed by an experienced team using a frameless approach results in outcomes comparable to those reported with the use of the frame-based technique.
Authors: Chioma Anidi; Johanna J O'Day; Ross W Anderson; Muhammad Furqan Afzal; Judy Syrkin-Nikolau; Anca Velisar; Helen M Bronte-Stewart Journal: Neurobiol Dis Date: 2018-09-06 Impact factor: 5.996
Authors: R W Anderson; Y M Kehnemouyi; R S Neuville; K B Wilkins; C M Anidi; M N Petrucci; J E Parker; A Velisar; H M Brontë-Stewart Journal: J Neurosci Methods Date: 2020-06-18 Impact factor: 2.390
Authors: Diane Whitmer; Camille de Solages; Bruce Hill; Hong Yu; Jaimie M Henderson; Helen Bronte-Stewart Journal: Front Hum Neurosci Date: 2012-06-04 Impact factor: 3.169
Authors: Yasmine M Kehnemouyi; Kevin B Wilkins; Chioma M Anidi; Ross W Anderson; Muhammad Furqan Afzal; Helen M Bronte-Stewart Journal: Brain Date: 2021-03-03 Impact factor: 15.255
Authors: Zack Blumenfeld; Anca Velisar; Mandy Miller Koop; Bruce C Hill; Lauren A Shreve; Emma J Quinn; Camilla Kilbane; Hong Yu; Jaimie M Henderson; Helen Brontë-Stewart Journal: PLoS One Date: 2015-03-25 Impact factor: 3.240