Accurate Deep Brain Stimulation Lead Placement Concurrent With Research Electrocorticography

Zachary Kons, Amir Hadanny, Alan Bush, Pranav Nanda, Todd M. Herrington, R. Mark Richardson

Research output: Contribution to journalArticlepeer-review


BACKGROUND: Using electrocorticography for research (R-ECoG) during deep brain stimulation (DBS) surgery has advanced our understanding of human cortical-basal ganglia neurophysiology and mechanisms of therapeutic circuit modulation. The safety of R-ECoG has been established, but potential effects of temporary ECoG strip placement on targeting accuracy have not been reported. OBJECTIVE: To determine whether temporary subdural electrode strip placement during DBS implantation surgery affects lead implantation accuracy. METHODS: Twenty-four consecutive patients enrolled in a prospective database who underwent awake DBS surgery were identified. Ten of 24 subjects participated in R-ECoG. Lead locations were determined after fusing postoperative computed tomography scans into the surgical planning software. The effect of brain shift was quantified using Lead-DBS and analyzed in a mixed-effects model controlling for time interval to postoperative computed tomography. Targeting accuracy was reported as radial and Euclidean distance errors and compared with Mann–Whitney tests. RESULTS: Neither radial error nor Euclidean distance error differed significantly between R-ECoG participants and nonparticipants. Pneumocephalus volume did not differ between the 2 groups, but brain shift was slightly greater with R-ECoG. Pneumocephalus volume correlated with brain shift, but neither of these measures significantly correlated with Euclidean distance error. There were no complications in either group. CONCLUSION: In addition to an excellent general safety profile as has been reported previously, these results suggest that performing R-ECoG during DBS implantation surgery does not affect the accuracy of lead placement.

Original languageEnglish
Pages (from-to)524-532
Number of pages9
JournalOperative Neurosurgery
Issue number5
StatePublished - 1 May 2023
Externally publishedYes

Bibliographical note

Publisher Copyright:
© Congress of Neurological Surgeons 2022. All rights reserved.


  • Deep brain stimulation
  • Electrocorticography
  • Microelectrode recording
  • Movement disorders
  • Stereotactic targeting


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