Simultaneous bilateral stereotactic procedure for deep brain stimulation implants: a significant step for reducing operation time

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Fonoff, Erich Talamoni ^{[1, 2]} ; Azevedo, Angelo ^[1] ; dos Angelos, Jairo Silva ^[1] ; Ruiz Martinez, Raquel Chacon ^[2] ; Navarro, Jessie ^[1] ; Reis, Paul Rodrigo ^[1] ; San Martin Sepulveda, Miguel Ernesto ^[1] ; Cury, Rubens Gisbert ^[1] ; dos Santos Ghilardi, Maria Gabriela ^[1] ; Teixeira, Manoel Jacobsen ^[1] ; Contreras Lopez, William Omar ^[1]

Afiliação do(s) autor(es)

^[1] Univ Sao Paulo, Sch Med, Dept Neurol, Div Funct Neurosurg, Inst Psychiat, Sao Paulo - Brazil

^[2] Hosp Siriolibanes, Inst Teaching & Res, Lab Neuromodulat, Sao Paulo - Brazil

• Tipo de documento: Artigo Científico
• Fonte: JOURNAL OF NEUROSURGERY; v. 125, n. 1, p. 85-89, JUL 2016.
• Citações Web of Science: 1

Resumo

OBJECTIVE Currently, bilateral procedures involve 2 sequential implants in each of the hemispheres. The present report demonstrates the feasibility of simultaneous bilateral procedures during the implantation of deep brain stimulation (DBS) leads. METHODS Fifty-seven patients with movement disorders underwent bilateral DBS implantation in the same study period. The authors compared the time required for the surgical implantation of deep brain electrodes in 2 randomly assigned groups. One group of 28 patients underwent traditional sequential electrode implantation, and the other 29 patients underwent simultaneous bilateral implantation. Clinical outcomes of the patients with Parkinson's disease (PD) who had undergone DBS implantation of the subthalamic nucleus using either of the 2 techniques were compared. RESULTS Overall, a reduction of 38.51% in total operating time for the simultaneous bilateral group (136.4 +/- 20.93 minutes) as compared with that for the traditional consecutive approach (220.3 +/- 27.58 minutes) was observed. Regarding clinical outcomes in the PD patients who underwent subthalamic nucleus DBS implantation, comparing the preoperative off-medication condition with the off-medication/on-stimulation condition 1 year after the surgery in both procedure groups, there was a mean 47.8% +/- 9.5% improvement in the Unified Parkinson's Disease Rating Scale Part III (UPDRS-III) score in the simultaneous group, while the sequential group experienced 47.5% +/- 15.8% improvement (p = 0.96). Moreover, a marked reduction in the levodopa-equivalent dose from preoperatively to postoperatively was similar in these 2 groups. The simultaneous bilateral procedure presented major advantages over the traditional sequential approach, with a shorter total operating time. CONCLUSIONS A simultaneous stereotactic approach significantly reduces the operation time in bilateral DBS procedures, resulting in decreased microrecording time, contributing to the optimization of functional stereotactic procedures. (AU)

• Processo FAPESP: 11/08575-7 - Papel da modulação dopaminérgica no núcleo lateral da amígdala sobre a resposta condicionada de esquiva
• Beneficiário: Raquel Chacon Ruiz Martinez
• Modalidade de apoio: Auxílio à Pesquisa - Jovens Pesquisadores