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Foltynie et al recently reported on the outcome of bilateral subthalamic stimulation (STN DBS) in Parkinson's disease (PD) using MRI-based targeting without microrecording and using one single trajectory per target, followed by immediate stereotactic MRI to verify targeting accuracy. The outcome in this series of 79 consecutive patients managed in the Unit of Functional Neurosurgery at the Queen Square in London is remarkable in terms of both safety and efficacy (see page 358).1
The leitmotif of this surgical school2 is that the first aim of elective functional surgery is not to harm, and so ventriculography was replaced by stereotactic CT early on,3 before moving to direct MRI-based targeting.4 Stereotactic imaging has become an integral part of the functional stereotactic procedure, performed under surgeons' direct supervision.1 Furthermore, the authors do not use microelectrode recording with multiple brain trajectories, in order to minimise the risk of brain haemorrhage.5 6 This is different from the practice in the vast majority of …
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Competing interests PK received research grant and reimbursement of travel costs to scientific meetings from Medtronic, a manufacturer of DBS devices, and from the following manufacturers of antiparkinsonian drugs: Euthérapie, Novartis, GSK, Boehringer Ingelheim, Lundbeck. He has served on the Advisory Board of Novartis.
Provenance and peer review Commissioned; not externally peer reviewed.