• Patient is a 64-year-old right-handed gentleman with initial diagnosis of Parkinson’s disease ten years prior to presentation.  His symptoms were reasonably managed with medical treatment for seven years. Over the past three years, patient had developed significant dyskinesia with motor fluctuations.  He had episodes of tremor, alternating with significant and uncontrollable movements of his arms. His wife stated that the intensity of his Parkinson’s syndrome was such that he could not hold a plate or a cup of coffee. He could not tie his shoes. Most of his symptoms at the time involved  his left side.

  
His appearance in clinic

• Patient was a considered a good candidate for implantation of right STN DBS (subthalamic nucleus deep brain stimulator).

A Leksell stereotactic frame was placed on his head in the preop area.


The DBS implantation equipment and are being prepared in the operating theater










Patient is brought and positioned comfortably in the operating room

Stereotactic planning: anterior and posterior comissure are being marked.


Anterior and posterior commisures are marked on the MRI.

Subthalamic nucleus is identified and marked visually

Microelectrode is being inserted along a trajectory to sub-thalamic nucleus for micro-recording while talking to the patient who is fully awake

Microelectrode recording is utilized to confirm the location of subthalamic nucleus



Postoperative MRI confirm the precise position of the electrode within subthalamic nucleus

• Patient’s tremor in Left upper extremity nearly completely resolved after the operation