Evolution of Globus Pallidus Targeting for Parkinson's and Dystonia Deep Brain Stimulation: A 15-Year Experience
Objective: The aim of this study is to evaluate the evolution of GPi DBS targeting.Methods: This retrospective, single-center study included patients implanted with GPi DBS leads for dystonia or PD during the years 2004 to 2018 at the University of Florida Fixel Institute for Neurological Diseases....
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doaj-809ba06d9c714a50958bac7963800d0d2021-08-12T05:02:47ZengFrontiers Media S.A.Frontiers in Neurology1664-22952021-08-011210.3389/fneur.2021.679918679918Evolution of Globus Pallidus Targeting for Parkinson's and Dystonia Deep Brain Stimulation: A 15-Year ExperienceVanessa M. Holanda0Robert Stephen Eisinger1Leonardo Almeida2Takashi Tsuboi3Huimin Wang4Michael S. Okun5Wissam Deeb6Addie Patterson7Aparna Wagle Shukla8Janine Lobo Lopes9Kelly Douglas Foote10Department of Neurosurgery, Center of Neurology and Neurosurgery Associates (NeuroCENNA), Beneficencia Portuguesa of São Paulo Hospital, São Paulo, BrazilDepartment of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida Health, Gainesville, FL, United StatesDepartment of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida Health, Gainesville, FL, United StatesDepartment of Neurology, Nagoya University, Nagoya, JapanDepartment of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida Health, Gainesville, FL, United StatesDepartment of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida Health, Gainesville, FL, United StatesDepartment of Neurology, University of Massachusetts Medical School, Worcester, MA, United StatesDepartment of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida Health, Gainesville, FL, United StatesDepartment of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida Health, Gainesville, FL, United StatesDepartment of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida Health, Gainesville, FL, United StatesDepartment of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida Health, Gainesville, FL, United StatesObjective: The aim of this study is to evaluate the evolution of GPi DBS targeting.Methods: This retrospective, single-center study included patients implanted with GPi DBS leads for dystonia or PD during the years 2004 to 2018 at the University of Florida Fixel Institute for Neurological Diseases. Each patient underwent a high-resolution targeting study on the day prior to the surgery, which was fused with a high resolution CT scan that was acquired on the day of the procedure. Intraoperative target location was selected using a digitized 3D Schaltenbrand-Bailey atlas. All patients underwent a high-resolution head CT scan without contrast approximately one month after lead implantation and accurate measurement of neuroanatomical lead position was acquired after fusion of pre-operative and post-operative image studies.Results: We analyzed 253 PD patients with 352 leads and 80 dystonia patients with 141 leads. During 15 years of follow-up, lead locations in the PD group migrated more laterally (β = 0.09, p < 0.0001), posteriorly [slope (β) = 0.04, p < 0.05], and dorsally (β = 0.07, p < 0.001), whereas leads in the dystonia group did not significantly change position aside from a trend in the dorsal direction (β = 0.06, p = 0.053).Conclusion: The evolving target likely results from multiple factors including improvements in targeting techniques and clinical feedback intraoperatively and post-operatively. Our demonstrates the potential importance of a systematic post-operative DBS lead measurement protocol to ensure quality control and to inform and optimize DBS programming.https://www.frontiersin.org/articles/10.3389/fneur.2021.679918/fulldeep brain stimulationglobus pallidustargetingdystoniaParkinson's disease |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Vanessa M. Holanda Robert Stephen Eisinger Leonardo Almeida Takashi Tsuboi Huimin Wang Michael S. Okun Wissam Deeb Addie Patterson Aparna Wagle Shukla Janine Lobo Lopes Kelly Douglas Foote |
spellingShingle |
Vanessa M. Holanda Robert Stephen Eisinger Leonardo Almeida Takashi Tsuboi Huimin Wang Michael S. Okun Wissam Deeb Addie Patterson Aparna Wagle Shukla Janine Lobo Lopes Kelly Douglas Foote Evolution of Globus Pallidus Targeting for Parkinson's and Dystonia Deep Brain Stimulation: A 15-Year Experience Frontiers in Neurology deep brain stimulation globus pallidus targeting dystonia Parkinson's disease |
author_facet |
Vanessa M. Holanda Robert Stephen Eisinger Leonardo Almeida Takashi Tsuboi Huimin Wang Michael S. Okun Wissam Deeb Addie Patterson Aparna Wagle Shukla Janine Lobo Lopes Kelly Douglas Foote |
author_sort |
Vanessa M. Holanda |
title |
Evolution of Globus Pallidus Targeting for Parkinson's and Dystonia Deep Brain Stimulation: A 15-Year Experience |
title_short |
Evolution of Globus Pallidus Targeting for Parkinson's and Dystonia Deep Brain Stimulation: A 15-Year Experience |
title_full |
Evolution of Globus Pallidus Targeting for Parkinson's and Dystonia Deep Brain Stimulation: A 15-Year Experience |
title_fullStr |
Evolution of Globus Pallidus Targeting for Parkinson's and Dystonia Deep Brain Stimulation: A 15-Year Experience |
title_full_unstemmed |
Evolution of Globus Pallidus Targeting for Parkinson's and Dystonia Deep Brain Stimulation: A 15-Year Experience |
title_sort |
evolution of globus pallidus targeting for parkinson's and dystonia deep brain stimulation: a 15-year experience |
publisher |
Frontiers Media S.A. |
series |
Frontiers in Neurology |
issn |
1664-2295 |
publishDate |
2021-08-01 |
description |
Objective: The aim of this study is to evaluate the evolution of GPi DBS targeting.Methods: This retrospective, single-center study included patients implanted with GPi DBS leads for dystonia or PD during the years 2004 to 2018 at the University of Florida Fixel Institute for Neurological Diseases. Each patient underwent a high-resolution targeting study on the day prior to the surgery, which was fused with a high resolution CT scan that was acquired on the day of the procedure. Intraoperative target location was selected using a digitized 3D Schaltenbrand-Bailey atlas. All patients underwent a high-resolution head CT scan without contrast approximately one month after lead implantation and accurate measurement of neuroanatomical lead position was acquired after fusion of pre-operative and post-operative image studies.Results: We analyzed 253 PD patients with 352 leads and 80 dystonia patients with 141 leads. During 15 years of follow-up, lead locations in the PD group migrated more laterally (β = 0.09, p < 0.0001), posteriorly [slope (β) = 0.04, p < 0.05], and dorsally (β = 0.07, p < 0.001), whereas leads in the dystonia group did not significantly change position aside from a trend in the dorsal direction (β = 0.06, p = 0.053).Conclusion: The evolving target likely results from multiple factors including improvements in targeting techniques and clinical feedback intraoperatively and post-operatively. Our demonstrates the potential importance of a systematic post-operative DBS lead measurement protocol to ensure quality control and to inform and optimize DBS programming. |
topic |
deep brain stimulation globus pallidus targeting dystonia Parkinson's disease |
url |
https://www.frontiersin.org/articles/10.3389/fneur.2021.679918/full |
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