In the city where I live there are only two surgical teams that do DBS on the STN and they differ in that one has a neurologist in theater and the other does not. This seems to have significant effect on DBS efficacy from talking to some patients that have undergone DBS of STN, so could you please comment on whether in your experience or in the literature a better outcome is on average achieved by a neurologist in theater, comparing the surgical procedures below.
Team "A" says that microelectrode recording should be interpreted only by a neurologist, not a neurosurgeon, and that functional testing by a neurologist in theater ensures a better outcome by better placement of the electrode leads. In addition they dim theater lighting to determine electrode lead depth by checking closeness to the optic nerve to check if the patient experiences phosphenes.
Team "B" says that accurate placement of electrode leads is the sole responsibility of the neurosurgeon who does microelectrode recording interpretation and that the electric field can be moved vertically by activating one of the four electrodes on a lead so there is no need for a neurologist to physically move a lead vertically to obtain the same effect. They also say that if an electrode lead placement in theater is suboptimal (e.g. laterally) for whatever reason, they cant partially extract it and try again two or three times or the STN will become "Swiss cheese" with several holes.
Thank you for your expert opinion as neurosurgery is a complex matter.