Deep Brain Stimulation: Awake and Asleep Options

“Good stereotactic surgery for movement disorders can be performed with or without the microelectrode, and poor surgical results can occur both with and without the microelectrode.” – Dr. Roy Bakay1 A BRIEF HISTORY OF DBS AND NEUROIMAGING Stereotactic neurosurgery is founded on the ability to accurately localize and safely access targets within the brain in a minimally-invasive manner. The stereotactic method was first described in 1908 by Sir Victor Horsley and Robert Clarke at University College London, where they developed an apparatus for animal experimentation that allowed them to establish a threedimensional Cartesian coordinate system for targeting. At that time, however, x-rays were the only available form of imaging the human body and as such, localizing intracranial targets relied on a combination of knowledge from anatomical atlases and the visualization of a few intracranial landmarks such as the pineal gland or the foramen of Monroe. These landmarks could be visualized by filling the ventricles with air (pneumoencephalogram) or a contrast medium (ventriculogram) [Figure 1]. In 1947, Ernst Spiegel and Henry Wycis created the first human stereotactic frame that allowed for lesioning of deep brain nuclei for the treatment of psychiatric disease.2