Exaktheit bei der Elektrodenpositionierung im Rahmen der Tiefen Hirnstimulation (THS): Eine Vergleichsstudie zwischen bilateraler und vier-Elektroden Implantationen

Deep Brain Stimulation (DBS) is an established treatment modality for various movement disorders and psychiatric conditions. The effectiveness of DBS largely hinges on the precise placement of electrode leads. However, inaccuracies in electrode positioning can lead to reduced treatment efficacy and adverse side effects. This study aims to compare the accuracy of electrode placement in bilateral DBS versus a four-lead DBS session, correlating the outcomes with clinical effectiveness.

52 patients with 128 leads, (40 patients in the bilateral group with 80 leads & 12 four-lead group with 48 leads) who received DBS at the University Hospital of Wuerzburg between 2013 and 2019 were reviewed. Preoperative planning and postoperative imaging (MRI and CT scans) were reviewed to assess lead placement accuracy for centrally implanted trajectories. Clinical outcomes, surgical sequelae, and stimulation parameters were evaluated through patient records.

The bilateral group exhibited a mean radial deviation of 1.40 mm from the planned trajectory, with a significant difference in accuracy between the first and second implanted leads. In the four-lead group, while there was an increasing trend in deviation from the first to the fourth electrode, it was not statistically significant. Brain shift, particularly due to cerebro-spinal fluid (CSF) leakage, was identified as a primary factor affecting lead placement accuracy. No significant correlations were found between lead displacement and clinical outcomes, including motor function and stimulation parameters.

This study contributes novel insights into the complexities of implanting multiple leads in a single DBS session. It highlights the importance of minimizing brain shifts during surgery to improve lead placement accuracy. The findings recommend prioritizing the implantation of the most clinically significant lead first, given the observed decrease in placement accuracy for subsequent leads.