Chapter 3 - Surgical placement of deep brain stimulation leads for the treatment of movement disorders: intraoperative aspects

Summary

This chapter focuses on the second critical factor for success of deep brain stimulation (DBS), namely the placement of the DBS lead. DBS implantation is a team-based neurosurgical procedure, led by a neurosurgeon who should be trained in functional, stereotactic neurosurgery. Intraoperative microelectrode recording (MER) does not cause morbidity but improves bradykinesia before placement of the DBS lead. Once the DBS lead has been placed at the target depth, intraoperative macro-stimulation using the DBS lead is performed to test for optimal placement. The goal of intraoperative DBS test stimulation is to assess the efficacy of placement and the therapeutic window of stimulation. A map should be made of the position of the DBS lead in the nucleus of choice, as this helps the clinician who ultimately performs the programming of the DBS system. Poor placement can result from lack of use of intraoperative physiological mapping techniques.