Intraoperative Microelectrode Recording and Targeting in Deep Brain Stimulation

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.