Deep brain stimulation in Parkinson's disease: a comparison of accuracy and clinical outcomes of frame-based, frameless and frameless fiducial-less techniques.
Riccardo Antonio Ricciuti, Matteo Maria Ottaviani, Fabrizio Mancini, Massimo Marano, Daniele Marruzzo, Francesca Barbieri, Riccardo Paracino, Pierfrancesco De Domenico, Serena Pagano, Vincenzo Di Lazzaro, Mauro Dobran
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引用次数: 0
Abstract
Background: The effectiveness of deep brain stimulation (DBS) for Parkinson's disease (PD) depends on implantation accuracy. DBS initially employed a stereotactic frame (frame-based, FB), but technological advancements led to the development of less invasive methods based on fiducial markers (F + F) or intraoperative imaging (F-F). This study compares the accuracy and efficacy of three DBS-STN implantation techniques.
Methods: This retrospective study involved 18 patients with PD who underwent bilateral STN DBS between 2018 and 2023. Patients were divided into three groups: FB (n = 6), F + F (n = 7), and F-F (n = 5). Postoperative CT and preoperative MRI fusion were used to evaluate electrode accuracy via deviations from planned targets in x, y, z axes, and calculate the radial error (RE) and vector error (VE). We analyzed Unified Parkinson's Disease Rating Scale (UPDRS) III scores in four "on/off medication-stimulation" combinations, LEDD, and disease stage before DBS, and 3 and 12 months post-DBS.
Results: No statistically significant differences were observed between the three methods in|Δx| (FB = 1.30 ± 0.91; F + F = 1.05 ± 0.93; F-F = 1.33 ± 1.09 mm),|Δy| (FB = 0.95 ± 0.98; F + F = 1.11 ± 1.17; F-F = 1.28 ± 1.14 mm), RE (FB = 1.82 ± 0.29; F + F = 1,71 ± 0,36; F-F = 1,91 ± 1,49 mm) and VE (FB = 3,14 ± 0,35 mm; F + F = 4,92 ± 0,54 mm; F-F = 4,42 ± 1,22 mm). All groups demonstrated significant UPDRS III (> 50%) and LEDD reduction (> 40%) at 12 months, with no intergroup differences.
Conclusions: The study concludes that all three techniques provide equivalent accuracy and clinical efficacy. Centers should select DBS-STN methods based on available resources and expertise.
期刊介绍:
Neurological Sciences is intended to provide a medium for the communication of results and ideas in the field of neuroscience. The journal welcomes contributions in both the basic and clinical aspects of the neurosciences. The official language of the journal is English. Reports are published in the form of original articles, short communications, editorials, reviews and letters to the editor. Original articles present the results of experimental or clinical studies in the neurosciences, while short communications are succinct reports permitting the rapid publication of novel results. Original contributions may be submitted for the special sections History of Neurology, Health Care and Neurological Digressions - a forum for cultural topics related to the neurosciences. The journal also publishes correspondence book reviews, meeting reports and announcements.