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mike51

Which surgical technique is better for STN DBS?

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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.

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It is in general very helpful to have a neurologist in the operating theater for Parkinson's disease DBS (microelectrode recording).  The microelectrode recording when paired with an intra-op exam by the neurologist can be very powerful and helpful.  Microelelctrode recording is only as good as the expert using the technique whether a neurologist or neurosurgeon.  Whether you use the technique or not, the most important aspect of care is detail to proper placement and testing (and imaging) post-operatively to assure the correct placement.

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The way you defined the two team processes, it almost sounds like Team B has no neurologist available for the operation.  Still I have seen different teams, depending on individual experience, assign different relative roles to its members... and to the equipment.

A few additional criteria you may wish to look into:

- which particular symptoms is the DBS implant addressing?  some are more demanding of accuracy and testing than others.

- is Team B maybe considering intra-operative MRI-based lead placement? or post-operative symptom testing before a 2nd stage for the IPG addition?

- the surgery is just the "first inning" of your treatment; just as important, for many patients in the long run, is a neurologist knowing where the leads are located relative to you individual symptoms, and going through a convergent process of programming the electrical field ... for each symptom of interest

I hope this helps.  Best wishes.

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