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CC BY 4.0 · J Neurol Surg Rep
DOI: 10.1055/a-2707-0593
Case Report

Half Burr-Hole Method: A Novel Surgical Technique for Reducing Brain Shift and Improving Electrode Placement Accuracy in Deep Brain Stimulation

Authors

  • Yosuke Ito

    1   Neurosurgery, Nishi Niigata Chuo National Hospital, Niigata, Japan (Ringgold ID: RIN34834)

  • Masafumi Fukuda

    1   Neurosurgery, Nishi Niigata Chuo National Hospital, Niigata, Japan (Ringgold ID: RIN34834)

  • Tomoyoshi Ota

    1   Neurosurgery, Nishi Niigata Chuo National Hospital, Niigata, Japan (Ringgold ID: RIN34834)

  • Hiroshi Masuda

    1   Neurosurgery, Nishi Niigata Chuo National Hospital, Niigata, Japan (Ringgold ID: RIN34834)

  • Makoto Oishi

    2   Niigata University Brain Research Institute Clinical Neuroscience Branch Department of Neurosurgery, Niigata, Japan (Ringgold ID: RIN594300)
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Deep brain stimulation (DBS) is used to treat movement disorders and drug-resistant focal epilepsy. However, electrode placement accuracy is affected by brain shift caused by pneumocephalus and cerebrospinal fluid (CSF) leakage during surgery. We present the novel half burr-hole method for improved DBS electrode placement accuracy. This approach was used to treat a 28-year-old man with drug-resistant epilepsy in whom stereo-electroencephalography revealed bilateral seizure onset in the temporal lobes, precluding focal resection. The patient, under general anesthesia, was placed in the supine position. Using a ROSA® robot-assisted surgical system, approximately 8-mm-deep "partial burr-holes" were created, with the deeper portion perforated using a 2.4-mm twist drill. Stimulation electrodes were placed bilaterally in the anterior thalamic nucleus. Directional leads were secured using standard burr-hole caps. Postoperative computed tomography confirmed a 0.46-cm³ pneumocephalus and electrode positioning with 0.47-mm (range: 0–1.62 mm) vector and 0.12-mm (range: 0.08–0.16 mm) axial errors relative to the target coordinates. Postoperative electrode impedance values were within the normal range. The half burr-hole method effectively minimizes CSF leakage and pneumocephalus during DBS surgery, reducing brain shift and enhancing electrode placement accuracy, and is compatible with standard burr-hole caps for electrode fixation, minimally affecting impedance values.



Publication History

Received: 16 May 2025

Accepted after revision: 21 September 2025

Accepted Manuscript online:
23 September 2025

© . The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

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