We propose to explore the feasibility of a new device to guide the placement of electrodes for deep- brain stimulation (DBS). DBS is employed to treat movement disorders including tremor, rigidity, and drug-induced side effects in patients with Parkinson's disease and essential tremor, which affect over 5,000,000 people in the United States. Contemporary treatment of these diseases as well as an emerging number of other focal neurological disorders involves high-frequency electrical stimulation. This form of therapy, which first received FDA approval in 1998, requires the placement of stimulating electrodes in the region of the mid or deep brain. Placement of these stimulators with an accuracy of two millimeters or better is essential for the success of the surgical procedure because the targeted nuclei are as small as four millimeters in width. Because the probe is placed through a small burr hole, initial placement of the probe must be based on registration of the patient in the operating room to a preoperative image in which the targeted position has been previously identified. In current practice this registration is accomplished by one of three means: a traditional stereotactic frame, a microstereotactic platform, or a fiducially-based tracking system. If the new device, which we call a "Microtable", is capable of placing the probe with sufficient accuracy, it will reduce the discomfort to the patient relative to the traditional frame, will reduce the duration of the time required from first hospital admission to final release relative to the platform, and will provide a more accurate initial placement error than the fiducial-based tracking system. The three current approaches are each based on commercially available devices, whereas the microtable is an experimental device, developed at our institution with NIH funding (1R01DC008408) for a totally different application-ear surgery. In that application the microtable guides a drill through bone to the cochlea as part of the procedure for the implantation of a cochlear stimulator. These applications are quite different, but phantom, cadaveric, and clinical testing of the device for cochlear implantation strongly suggest that the microtable is likely to have the accuracy necessary for DBS as well. Successful translation of this methodology from ear surgery to brain surgery will provide an opportunity to take advantage of the work already done on this device to make it available to an entirely new population of patients.
A new device will be tested to guide surgery for deep-brain stimulation in order to treat movement disorders, from which five million people suffer in the United States. If successful, it will provide the accuracy of the best devices currently available but with reduced discomfort and reduced delay from first admission to release from the hospital, potentially benefiting all who suffer from this illness.