Best surgical practices: a stepwise approach to the University of Pennsylvania deep brain stimulation protocol.

Abstract:

:Deep brain stimulation (DBS) is the treatment of choice for otherwise healthy patients with advanced Parkinson disease who are suffering from disabling dyskinesias and motor fluctuations related to dopaminergic therapy. As DBS is an elective procedure, it is essential to minimize the risk of morbidity. Further, precision in targeting deep brain structures is critical to optimize efficacy in controlling motor features. The authors have already established an operational checklist in an effort to minimize errors made during DBS surgery. Here, they set out to standardize a strict, step-by-step approach to the DBS surgery used at their institution, including preoperative evaluation, the day of surgery, and the postoperative course. They provide careful instruction on Leksell frame assembly and placement as well as the determination of indirect coordinates derived from MR images used to target deep brain structures. Detailed descriptions of the operative procedure are provided, outlining placement of the stereotactic arc as well as determination of the appropriate bur hole location, lead placement using electrophysiology, and placement of the internal pulse generator. The authors also include their approach to preventing postoperative morbidity. They believe that a strategic, step-by-step approach to DBS surgery combined with a standardized checklist will help to minimize operating room mistakes that can compromise targeting and increase the risk of complication.

journal_name

Neurosurg Focus

journal_title

Neurosurgical focus

authors

Kramer DR,Halpern CH,Buonacore DL,McGill KR,Hurtig HI,Jaggi JL,Baltuch GH

doi

10.3171/2010.4.FOCUS10103

subject

Has Abstract

pub_date

2010-08-01 00:00:00

pages

E3

issue

2

issn

1092-0684

journal_volume

29

pub_type

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