On-Site DBS Support Services - Case Report
Alpha Omega Gold Service
This case-report describes the use of innovative technologies as part of Alpha Omega’s Gold Service during a DBS surgery and the way those technologies affect Intraoperative clinical decisions.
The intraoperative Microelectrode Recording (MER) system used in the surgery is
Microelectrode recording (MER) is a common practice during DBS procedures in which neural recording and stimulation are used for DBS target localization. During MER phase, one or more micro-electrodes are used, to record the neural activity in order to determine the DBS lead implantation location.
Interpretation of the recorded signal and optimal implantation location recommendation demands significant experience and the presence of a Neurophysiologist in the OR.
|Dominant symptoms||Tremor, Rigidity|
|DBS Target||Bottom of left STN|
|MER Setup||Neuro Omega with Electrical drive|
Tools and Technologies Used
Neuro Omega System
is a real time software solution designed to accurately detect the STN and GPi regions and its entrance and exit boundaries using microelectrode recording during surgery. The HaGuide also detects STN subregions boundaries; Dorso Lateral Oscillatory Region (DLOR) and Ventro Medical non-oscillatory region (VMNR).
Neuro Omega Drive Headstage
Abbott 6180 segmented lead
1. Starting depth was set to 25 mm above target.
2. Neurosurgeon activated the HaGuide
Distance from planned target (mm)
|DLOR||6.5 - 4|
|VMNR||4 - 0.5|
|3. Once the HaGuide has identified the STN in all trajectories, it recommends the optimal location for stimulation to the neurosurgeon.|
4. After confirming the implantation location, Neurosurgeon Implanted Abbott 6180 segmented lead, locating bottom of Contact 1 (see figure 4)at 0.5mm above target the bottom of STN border as detected by HaGuide, “A” contact faces posterior.
5. After placing the lead in the desired depth, Neurosurgeon connected the lead to the headstage using Alpha Omega’s Sterile LeadConfirm-A Cable.The LeadConfirm recording showed strongest beta frequencies on Contacts 3A, 3B and 3C on the referential graphs, as well as beta activity on all differential recordings between the segments 3A-2A, 3B-2B and 3C-2C which are an indication that the lead is fully inside the STN.
compatible with Medtronic’s DBS leads
compatible with Boston Scientific’s DBS leads
compatible with Abbott’s DBS leads
The MER interpretation results by the doctor showed STN entry at ~6.5mm above target, and STN exit at ~0.5mm above target, combined with somatosensory testing which confirmed motor response twice between 6.5mm and 4mm above target.
The HaGuide and LeadConfirm results side by side
In these results we can see the third lead contact is completely inside the motor region according to the HaGuide results. The LeadConfirm results provide spatial information about the location of the lead contacts, the results are showing that segments A, B and C of contact 3 are all recording beta frequency which is an indication of STN motor region.
Intra-operative imaging confirmed that the 3rd contact segments are in the dorsal part of the STN.
Stimulation testing confirmed a good therapeutic window on the 3rd contact segments, the other contacts and segments were less effective.
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