Frame-based stereotactic deep brain stimulation for parkinson's disease: 12 months outcomes for patients in cross hair versus non-cross hair application groups

Background: Because deep brain stimulation (DBS) implantations and other stereotactic and functional surgical procedures require accurate, precise, and safe targeting of the brain structure, the technical aids for preoperative planning, intervention, and postoperative follow-up have become increasingly important. In this paper, we compare the outcomes of advanced Parkinson's disease (PD) patients at our center who received frame-based DBS surgery involving the use of a cross hair with those for patients who received the surgery without the application of the cross hair. A preliminary outcomes analysis is also provided. Methods and Techniques: Seventeen patients (10 male and 7 female; mean age: 64.8 ± 9.0 years) with advanced PD underwent frame-based DBS surgery, 8 with noncross hair and 9 with cross hair frame-based stereotaxy. After identifying the coordinates of the subthalamic nuclei, the DBS electrodes were implanted with or without crosshair application and connected to an implanted programmable generator in all patients. Programming started 1 month after the operation, and the patients were followed-upon regularly for at least 6 months. Results: After 12 months of follow-up, the patients who received DBS surgery showed improvements in clinical outcome, especially those in the frame-based cross hair group, which resulted in a significantly higher degree of improvement in both the "On" and "Off" states of the postoperative state (cross hair Unified PD Rating Scale [UPDRS] in the "Off" state: Preoperative: 82.3 ± 15.4 vs. postoperative: 37.9 ± 9.4; P < 0.001; UPDRS in the "On" state: Preoperative: 47.8 ± 13.6 vs. postoperative "On" state: 28.6 ± 6.0; P < 0.01, paired t-test). However, improvements were shown only in the "On" state of the noncross hair group (noncross hair group UPDRS in the "Off" state: Preoperative: 71.7 ± 16.6 vs. postoperative 48.9 ± 24.4; P < 0.05; "On" state: Preoperative: 55.2 ± 19.1 vs. postoperative: 42.6 ± 27.8; P > 0.05, paired t-test). Conclusion: Targeting accuracy can be increased by detailed preoperative planning and good facilitating equipment. Crosshair application with a frame-based system provides higher accuracy in the postoperative lead position survey and target deviation measurements compared with the preoperative planning image. Furthermore, the outcomes of the DBS group with cross hair application were better than those of the noncross hair application group.