A single centre experience of asleep, robotic, intraoperative image-guided, single-stage deep brain stimulation (DBS) surgery for movement disorders

Deep brain stimulation (DBS) is an established treatment for movement disorders. However, there remains a wide variation in practice of surgical technique, such as the use of a stereotactic frame, robotic guidance, awake or asleep surgery, intraoperative imaging, and microelectrode recording (MER). This report aims to share the surgical workflow and outcomes of the first 50 patients undergoing DBS at our institution. This is a retrospective descriptive study including all patients who underwent DBS for movement disorders from November 2021 until November 2024. A description of the perioperative and intraoperative workflow is given. Patient demographics, pathology, surgical targets, and implant brands used are reported. Outcome measures including robotic registration accuracy, frequency of lead placement error requiring lead adjustment, complications, degree of symptom improvement following programming sessions, and neuropsychiatric and quality of life outcomes are reported. 50 consecutive patients were included in this study. 62% had a diagnosis of Parkinson's disease (PD), 28% dystonia, and 10% essential tremor (ET). 30% of patients required intraoperative adjustments to their lead placement, with 47% of these adjustments requiring adjustment to the trajectory. Patients with Globus Pallidus internus (GPi) targets had a higher odds of requiring an intraoperative adjustment to electrode depth, possibly to avoid the visual side effects from stimulation of the optic tracts. All patients had symptomatic improvement, and most patients with PD had improvements in mood and quality of life following DBS. 9 patients with PD had transient delirium post operatively, and 11 had small reductions in cognition at 6 months follow up that correlated with advanced age. There were no haemorrhagic complications, one patient required a reoperation for infection, and one patient required a reoperation due to late lead migration. DBS surgery employing our workflow is safe, effective, and versatile.