A Comparison of Unilateral Deep Brain Stimulation (DBS), Simultaneous Bilateral DBS, and Staged Bilateral DBS Lead Accuracies

Single-Stage Deep Brain Stimulator Placement for Movement Disorders: A Case Series

“…Little data exists to suggest the practice of staging is superior. Arguments for staging have included improved electrode accuracy, reduced operative time, and concerns for increased post-operative confusion or other complications [ 4 , 5 ].…”

“…Some authors have referred to “staging” as individually placing only one of two planned intracranial electrodes at a time, and studies have compared simultaneous bilateral electrode placement with implantation of each hemisphere in two separate surgeries [ 5 , 6 ]. Peng, et al concluded that there was no significant difference in lead accuracy between unilateral, simultaneous bilateral, and staged bilateral electrode placement [ 5 ].…”

“…Reasons to separate DBS implantation into multiple surgeries vary, including concerns for increased risk of infection, poor stimulation efficacy, and postoperative confusion leading to increased length of stay, particularly when intraoperative microelectrode (MER) recording and neurophysiological testing are used [ 4 , 5 ]. In an effort to simplify care and reduce the burden of multiple surgeries on patients, a single-stage approach has been used routinely in the senior author’s practice since his arrival at our institution.…”

Segmented versus Nonsegmented Deep-Brain Stimulation for Essential Tremor Differ in Ataxic Side Effects

“…Since the advent of lesion-based therapy for movement disorders, successful reduction of motor symptomatology has highly correlated with both accurate target localization as well as accurate lesion creation 6. Deep-brain stimulation surgery is no exception, but at least has offered the ability to modify the lesion effect as an advantage over traditional lesion creation 7.…”

“…Since the advent of lesion-based therapy for movement disorders, successful reduction of motor symptomatology has highly correlated with both accurate target localization as well as accurate lesion creation. 6 Deep-brain stimulation surgery is no exception, but at least has offered the ability to modify the lesion effect as an advantage over traditional lesion creation. 7 Despite controlling for a number of variables through improved technologies such as enhanced neuroimaging, advances in planning software, and advents in microelectrode recording, stimulating electrodes may ultimately be implanted away from the intended target by varying distances unintended at the time of planning.…”