• Christiane Reck, Mohammad Maarouf, Lars Wojtecki, Stefan Jun Groiss, Esther Florin, Volker Sturm, Gereon R Fink, Alfons Schnitzler, and Lars Timmermann.
• Department of Neurology, University Hospital Cologne, Cologne, Germany. christiane.reck@uk-koeln.de
• J Neurol Surg A Cent Eur Neurosurg. 2012 Nov 1;73(6):377-86.

Background And Study AimsThe use of multiple trajectories microelectrode recording (MER) during implantation of deep brain stimulation (DBS) electrodes into the subthalamic nucleus (STN) in patients with Parkinson's disease (PD) is discussed controversially because of possible risks and unclear benefits. The aim of the study is to investigate whether MER combined with intraoperative evaluation of stimulation effects improve clinical outcome in PD patients undergoing STN DBS surgery.Material And MethodsPrior to final DBS electrode implantation, we performed multiple trajectories MER and intraoperative test stimulations after magnetic resonance imaging (MRI)-guided planning in 32 PD patients. In further 10 patients no MER (only intraoperative test stimulation) was used.ResultsWe found a significantly better clinical outcome (Unified Parkinson's Disease Rating Scale [UPDRS] III) in patients undergoing MER compared with non-MER patients. In MER patients, DBS electrode placement was performed using the central trajectory in 73%. Another than the central trajectory was taken in 27% of the patients. No difference in clinical outcome between DBS electrodes implanted on the central or a decentral trajectory was observed.ConclusionsDBS surgery based on intraoperative multiple trajectories MER and test stimulation improves clinical outcome if compared with intraoperative test stimulation alone. The data suggest that DBS surgery solely based on MRI and intraoperative test stimulation without MER may lead to nonoptimal placement of DBS electrodes and consequently poorer clinical outcome.Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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