An intraoperative MER by LeadPoint (Medtronic) was performed for both groups. In the GA group, 1% propofol 2–4 mL/kg/h and remifentanil 0.5–1.0 μg/kg/min were pumped to maintain anesthesia. Bispectral index monitoring (Bis) was performed during the operation, and the Bis was maintained ≥70 at the beginning of the MER. Microelectrodes were implanted into the guide tube and inserted into the target via a Microdrive. The MER was recorded in 1 mm steps from 10 to 5 mm above the target, 0.5 mm steps until substantia nigra (SN) activity appeared, or until the STN activity disappeared. The MER was analyzed and recorded by two specialized electrophysiologists during the operation. There are two typical forms of STN nuclear discharges. The lateral STN showed continuous and irregular high-frequency discharges with a high density of local neurons, while the medial STN showed a continuous and irregular medium and high-frequency discharges [9 (link),10 (link)]. The discharge in the reticular part of the SN is regular, continuous, and high frequency, while the density of the local neurons is lower than that in the STN [11 (link)] (Figure 2 ).
Leadpoint
Manufactured by Medtronic
Sourced in United States
LeadPoint is a laboratory equipment product offered by Medtronic. It serves as a data collection and analysis tool for clinical and research applications. The device is designed to capture and process data from various medical sensors and instruments.
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Lab products found in correlation
5 protocols using leadpoint
1
Intraoperative Microelectrode Recording in Deep Brain Stimulation
2
Intraoperative Microelectrode Recording and Targeting in Deep Brain Stimulation
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The signal acquired from microelectrode tip was transferred to the micro-recording system (Leadpoint; Medtronic, United States) (Jiang et al., 2021 (link)). Those signals were magnified and displayed in the screen. Both in awake and asleep groups, passive movement tests of contralateral limbs were done and repeated for observing any movement-evoking neuronal firing changes during microelectrode penetrating toward STN (Chen et al., 2018 (link)). In awake group, the patients received macrostimulation test up to 5 V for side effects. A neurologist, neurosurgeon, and anesthesiologist analyzed signals together. A final appropriate trajectory was selected based on satisfactory signals. Intraoperative fluoroscopy by a C-arm X-ray machine was used for marking microelectrode tip location. The quadripolar electrodes (Model 3,389, Medtronic, MN, United States) were implanted into STN along the above trajectory. Further intraoperative fluoroscopy by a C-arm X-ray machine was used to accurately localize the target by adjusting the electrodes with a comparison of microelectrode tip location maker.
3
Intraoperative Neural Firing Analysis for STN
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Neural firings obtained from the tip of the microelectrode (FHC, Bowdoin, ME, USA) were sent to the intraoperative MER system (Leadpoint; Medtronic) where they were magnified and displayed. The sampling rate was 24 kHz. For both groups of patients, passive movement of the contralateral limb was tested during MER in the STN to observe whether there were any movement-related neuronal firing changes. The selection of the final trajectory for electrode implantation depended on adequate length of STN hyperactivity neuronal firing and the presence of movement-related firing-pattern changes. In the LA group, stimulation of up to ~4–5 V was done to test for adverse effects and the immediate effectiveness of each individual electrode. We did not perform any intraoperative test stimulation in the GA group.
4
Deep Brain Stimulation Targeting Procedure
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Magnetic resonance imaging (MRI) was scanned after fixation of the stereotactic Leksell Coordinate Frame (Elekta®, Stockholm, Sweden). These scans were then fused and registered with the MRI performed before surgery in the surgical planning system. Based on the indication provided by Schiff et al. ], the bilateral CM-pf were targeted. Multi-channel microelectrodes (leadpoint, Medtronic, USA) were implanted, and the electrical signals were recorded from 10 mm above the target down to 2 mm below it and we used the signal within a 1mm range above and below the target as the data for subsequent analysis. All procedures were conducted under general anesthesia. The administration of propofol and sevoflurane, which could influence neuronal firing, were discontinued 20 min prior to the microelectrode recording (MER). Two quadripolar electrodes (PINS L302, Beijing PINS) were positioned at the target site based on the microelectrode trajectory on both sides. To assist more accurate localization, the LFP signals were filtered out to enhance the observation of firing activities. Postoperative CT OR 1.5T MRI were performed to verify the position of DBS electrodes (Fig. S1).
5
Microelectrode Recording of Neuronal Firing
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The microelectrode was 10–40 μm in diameter and 200 mm in length and had a <50-μm tungsten tip and recording impedance between 0.5 MΩ and 1 MΩ. The microelectrode signal was recorded using an intraoperative MER system (LeadPoint; Medtronic, Fridley, MN, USA) where the signal was amplified (×10) and filtered (300–3 kHz). Recording started at 10 mm above the planned target coordinates. The microelectrode was advanced in steps of 200–500 µm, with pauses at sites of robust neuronal firing. Firing at each depth was recorded for the no-MNS, MNS-5, MNS-20, and MNS-90 conditions. The latency of discharge from each depth was recorded for 10 s.
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