The Columbia University Experience with 169 Consecutive Subthalamic Stimulator Implantations in Patients with Medically Refractory Parkinson's Disease
Robert R Goodman MD, PhD1, Brian Kim BA1, Shearwood McClelland III BA1, Patrick B Senatus MD, PhD1, Blair Ford MD2, Linda M Winfield RN, MPH2, Seth L Pullman MD, FRCPC2, Qiping Yu PhD2, Guy M McKhann II MD1
1Departments of Neurological Surgery and 2Neurology, Columbia University, College of Physicians and Surgeons, New York, NY
Introduction: Subthalamic nucleus (STN) stimulation for patients with advanced Parkinson's disease (PD) patients is expanding. Reported experience (few centers reporting more than fifty patients) has provided some indication of techniques, efficacy and morbidity. To expand this knowledge, the authors review their experience with a large series of consecutive patients.
Methods: Between March 1999 and March 2003, 169 subthalamic stimulator devices (17 unilateral) were implanted in 90 PD patients at Columbia-Presbyterian Medical Center. Sixteen patients had a prior surgery for PD (pallidotomy, thalamotomy or fetal transplant). Microelectrode guided implantations were performed by two surgeons (RRG - 79 patients, GMM - 11 patients), using techniques similar to those described by Starr et al. (J Neurosurg 97:370, 2002). Electrode implantation, anchored with a titanium plate, occurred 1 week before outpatient pulse generator implantation.
Results: Reductions of dyskinesias and off severity/duration were similar to prior published reports. Magnetic resonance imaging (MRI) of electrode locations (52 electrodes in 26 patients) found tips within a 3 mm radius cylinder of the intended path, with no correlation of location with therapeutic efficacy. Morbidity included: 9 device infections (5.3%), 1 cerebral infarct, 1 intracerebral hematoma, 2 subdural hematomas, 2 wound hematomas requiring drainage, 3 periprocedural seizures, 5 brain electrode revisions (3%), postoperative confusion in 12 patients (7.1%), and 2 skin erosions over implanted hardware. No patient had a permanent new neurologic deficit. Hospital stay averaged 4 days for the electrode implantation.
Conclusions: Subthalamic stimulator implantation in a large consecutive series of PD patients produced significant clinical improvement without major neurologic morbidity. Morbidity primarily involved device infections and hardware/wound revisions.