• Kazutaka Kobayashi, Suguru Nakamura, Mitsuru Watanabe, Kentaro Shimoda, Takashi Morishita, Koichiro Sumi, Toshiharu Otaka, Toshiki Obuchi, Katsunori Shijyo, Toshikazu Kano, Hideki Oshima, Chikashi Fukaya, Takamitsu Yamamoto, and Yoichi Katayama.
• Division of Applied System Neuroscience, Department of Advanced Medical Science, Nihon University School of Medicine, Tokyo, Japan.
• Neuromodulation. 2013 Jan 1;16(1):51-4; discussion 54.

Background And ObjectiveDeep brain stimulation (DBS) candidates with neurologic diseases such as unruptured aneurysm present additional challenges to neurosurgeons when craniotomy must precede DBS surgery. Such craniotomy may potentially overlap with intended burr hole sites for the later insertion of DBS electrodes, and the skin incision for craniotomy may lie very close to or intersect with that for the burr holes. We report here a case of forehead craniotomy prior to DBS surgery in which we employed a neuronavigation system to simulate locations for the craniotomy and burr holes.Method  A 62-year-old male patient with Parkinson's disease was a candidate for DBS. He also had an aneurysm and was planned first to undergo frontal craniotomy for clipping before the DBS surgery. The locations of the craniotomy, burr holes, and skin incisions were therefore simulated using a neuronavigation system during craniotomy.ResultsTwo weeks after the craniotomy, the patient underwent DBS surgery. Planning software confirmed the absence of cortical veins beneath the entry points of tentative burr holes and aided trajectory planning. The DBS surgery was performed without the interference of the burr holes and head pins and the craniotomy.ConclusionSimulation of the locations of craniotomy and burr holes using a neuronavigation system proved valuable in the present case of frontal craniotomy before DBS surgery.© 2012 International Neuromodulation Society.

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