Background and Objectives: Individually manufactured microTargeting™ platforms (MT) provide a novel generation of stereotactic systems based on preoperatively implanted bone markers and screws. The feasibility and reliability of these frames were evaluated for bilateral deep brain stimulation (DBS) in patients with idiopathic Parkinson's disease (IPD). Surgical and clinical results were compared to conventional Zamorano Dujovny frames (ZD) in this prospective study. Materials and Methods: Twenty-six IPD patients undergoing surgery for DBS were divided into 2 groups. In group I, electrode implantation was accomplished using conventional ZD. Group II underwent electrode implantation using MT. Microrecording and macrostimulation were performed and surgery time was measured. The clinical outcome was determined using the Unified Parkinson's Disease Rating Scale Part III (UPDRS III) and L-dopa-equivalent doses for a 12-month follow-up postoperatively. Results: Clinical evaluation confirmed comparable outcomes for both targeting procedures and electrode positioning. Surgical time was lower in group II than in group I. Significant improvements were determined for both groups in UPDRS III and L-dopa-equivalent dose. Conclusions: Both systems allow for reliable and safe neurosurgical procedures, yielding comparable clinical results. MT improved handling and automatic adjustment of frame coordinates. Surgery time was reduced markedly compared to conventional frames.

Keywords:
Deep brain stimulation, Idiopathic Parkinson disease , STarFix microTargeting™ platform, Stereotaxy, Subthalamic nucleus
1.
Limousin P, Krack P, Pollak P, Benazzouz A, Ardouin C, Hoffmann D, Benabid AL: Electrical stimulation of the subthalamic nucleus in advanced Parkinson's disease. N Engl J Med 1998;339:1105-1111.
2.
Kupsch A, Earl C: Neurosurgical interventions in the treatment of idiopathic Parkinson disease: neurostimulation and neural implantation. J Mol Med 1999;77:178-184.
3.
Valálik I, Sági S, Solymosi D, Julow J: CT-guided unilateral thalamotomy with macroelectrode mapping for the treatment of Parkinson's disease. Acta Neurochir (Wien) 2001;143:1019-1030.
4.
Starr PA, Christine CW, Theodosopoulos PV, Lindsey N, Byrd D, Mosley A, Marks WJ: Implantation of deep brain stimulators into the subthalamic nucleus: technical approach and magnetic resonance imaging-verified lead locations. J Neurosurg 2002;97:370-387.
5.
Fox MW, Ahlskog JE, Kelly PJ: Stereotactic ventrolateralis thalamotomy for medically refractory tremor in post-levodopa era Parkinson's disease patients. J Neurosurg 1991;75:723-730.
6.
Moriyama E, Beck H, Miyamoto T: Long-term results of ventrolateral thalamotomy for patients with Parkinson's disease. Neurol Med Chir (Tokyo) 1999;39:350-356; discussion 356-357.
7.
Spottke EA, Volkmann J, Lorenz D, Krack P, Smala AM, Sturm V, Gerstner A, Berger K, Hellwig D, Deuschl G, Freund HJ, Oertel WH, Dodel RC: Evaluation of healthcare utilization and health status of patients with Parkinson's disease treated with deep brain stimulation of the subthalamic nucleus. J Neurol 2002;249:759-766.
8.
Brophy BP, Kimber TJ, Thompson PD: Thalamotomy for Parkinsonian tremor. Stereotact Funct Neurosurg 1997;69:1-4.
9.
Kopper F, Volkmann J, Müller D, Mehdorn M, Deuschl G: High-frequency deep brain stimulation in the treatment for Parkinson's disease, tremor and dystonia. Der Nervenarzt 2003;74:709-725.
10.
Fitzpatrick JM, Konrad PE, Nickele C, Cetinkaya E, Kao C: Accuracy of customized miniature stereotactic platforms. Stereotact Funct Neurosurg 2005;83:25-31.
11.
Patil AA, Falloon T, Hahn F, Cheng J, Wang S: Direct identification of ventrointermediate nucleus of the thalamus on magnetic resonance and computed tomography images. Surg Neurol 1999;51:674-678.
12.
Schulder M, Fontana P, Lavenhar MA, Carmel PW: The relationship of imaging techniques to the accuracy of frameless stereotaxy. Stereotact Funct Neurosurg 1999;72:136-141.
13.
Konrad PE, Neimat JS, Yu H, Kao CC, Remple MS, D'Haese P, Dawant BM: Customized, miniature rapid-prototype stereotactic frames for use in deep brain stimulator surgery: initial clinical methodology and experience from 263 patients from 2002 to 2008. Stereotact Funct Neurosurg 2011;89:34-41.
14.
Ohye C: The idea of stereotaxy toward minimally invasive neurosurgery. Stereotact Funct Neurosurg 2000;74:185-193.
15.
Ostertag CB, Warnke PC: Neuronavigation. Computerassistierte Neurochirurgie. Nervenarzt 1999;70:517-521.
16.
Dujardin K, Defebvre L, Krystkowiak P, Blond S, Destée A: Influence of chronic bilateral stimulation of the subthalamic nucleus on cognitive function in Parkinson's disease. J Neurol 2001;248:603-611.
17.
Siegfried J: Therapeutic stereotactic procedures on the thalamus for motor movement disorders. Acta Neurochir (Wien) 1993;124:14-18.
18.
Holloway KL, Gaede SE, Starr PA, Rosenow JM, Ramakrishnan V, Henderson JM: Frameless stereotaxy using bone fiducial markers for deep brain stimulation. J Neurosurg 2005;103:404-413.
19.
Brommeland T, Hennig R: A new procedure for frameless computer navigated stereotaxy. Acta Neurochir (Wien) 2000;142:443-447.
20.
Dötterl A, Trappe AE, Al-Hami S: Optimized visualization of contrast medium dependent differences in CT/MRI scans by RGB transformation. Minim Invasive Neurosurg 1999;42:194-197.
21.
Hariz MI, Bergenheim AT: A comparative study on ventriculographic and computerized tomography-guided determinations of brain targets in functional stereotaxis. J Neurosurg 1990;73:565-571.
22.
Winkler D, Tittgemeyer M, Schwarz J, Preul C, Strecker K, Meixensberger J: The first evaluation of brain shift during functional neurosurgery by deformation field analysis. J Neurol Neurosurg Psychiatr 2005;76:1161-1163.
23.
Parasuraman R, Sheridan TB, Wickens CD: A model for types and levels of human interaction with automation. IEEE Trans Syst Man Cybern A Syst Hum 2000;30:286-297.
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2013
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