Refining Stereotaxic Deep Brain Stimulation Surgery Procedures for Parkinson Disease in Pursuit of Zero Pneumocephalus: 2-Dimensional Operative Video.

BACKGROUND AND

OBJECTIVES

Deep brain stimulation (DBS) is a well-established intervention for alleviating both motor and nonmotor symptoms of Parkinson disease. However, a common complication of stereotaxic DBS surgery is pneumocephalus, which can compromise electrode accuracy, complicate postoperative assessments, and negatively affect the long-term outcomes of DBS surgery. This report proposes a comprehensive and robust set of recommendations aimed at optimizing DBS surgical protocols to achieve zero pneumocephalus outcomes.

METHODS

A retrospective analysis was undertaken on 138 patients with Parkinson disease who underwent simultaneous bilateral stereotaxic DBS targeting either the subthalamic nucleus or the globus pallidus internus at a single institution. The study compared the pneumocephalus volume and postsurgical electrode tip displacement between the original surgical technique and a refined procedure that incorporated modified supine position, dural puncture, and liquid sealing.

RESULTS

With the implementation of the refined procedure, the volume of pneumocephalus significantly decreased from 14.40 ± 17.00 to 0.32 ± 1.02 mL, with 92.9% of patients showing no visible pneumocephalus or intracranial air less than 1 mL. In addition, the refined procedure was associated with less electrode tip displacement in the postoperative stage.

CONCLUSION

The refined procedure effectively minimized the average pneumocephalus volume to approximately 0, and bilateral DBS electrodes exhibited enhanced stability during the postoperative stage.