• Kristen M Scheitler, Aaron E Rusheen, Jason Yuen, Abhinav Goyal, Sukwoo Hong, Gamaleldin M Osman, Basel Sharaf, Bryan T Klassen, Sanjeet S Grewal, Kai J Miller, Hojin Shin, Yoonbae Oh, and Kendall H Lee.
• Departments of1Neurologic Surgery.
• J. Neurosurg. 2024 Aug 1; 141 (2): 406411406-411.

ObjectiveConventional frame-based stereotactic systems have circumferential base frames, often necessitating deep brain stimulation (DBS) surgery in two stages: intracranial electrode insertion followed by surgical re-preparation and pulse generator implantation. Some patients do not tolerate awake surgery, underscoring the need for a safe alternative for asleep DBS surgery. A frame-based stereotactic system with a skull-mounted "key" in lieu of a circumferential base frame received US FDA clearance. The authors describe the system's application for single-stage, asleep DBS surgery in 8 patients at their institution and review its workflow and technical considerations.MethodsEight patients underwent DBS lead insertion and IPG implantation in a single surgical preparation under general anesthesia using the system. Postoperative CT imaging confirmed lead placement.ResultsEight patients underwent implantation of 15 total leads targeting the ventral intermediate nucleus (4 patients), globus pallidus internus (GPi; 3 patients), and subthalamic nucleus (STN; 1 patient). Intraoperative microelectrode recording was conducted for GPi and STN targets. Postoperative CT imaging revealed a mean ± SD radial error of 1.24 ± 0.45 mm (n = 15 leads), without surgical complications.ConclusionsThe stereotactic system facilitated safe and effective asleep, single-stage DBS surgery, maintaining traditional lead accuracy standards.

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