January 5, 2026

@michaelokun

When air shifts the brain, physiology can save the day during DBS surgery. Microelectrode recording is a technique that listens to real time brain cell signals during surgery in an effort to confirm the location of a target. Walker-Pizarro and colleagues describe in a new paper in Tremor and Other Hyperkinetic Movements a real world DBS case where 'pneumocephalus' threatened accurate lead placement, and how physiology changed the outcome. Key Points: - Intraoperative pneumocephalus can shift deep brain targets by several millimeters and quietly undermine image based DBS accuracy. - Microelectrode recording exposed a mismatch between planned imaging and true subthalamic nucleus location. - The technique guided a major corrective adjustment. - Physiology guided repositioning and restored a wider therapeutic window and produced a strong motor benefit. My take: This case is a reminder that the brain is dynamic during surgery. Imaging offers us a map, however physiology tells us where we truly are when the terrain moves. Nur is a fellow at UF and I am an author on this study. I am biased, so please read for yourself and decide. Here are 5 points that resonated w/ me: 1- Brain shift is not rare, and even small shifts can matter when margins are measured in millimeters. 2- Microelectrode recording acts as a real time safeguard when anatomy is no longer static. 3- Low stimulation thresholds and changes in MER are warning signs that should not be ignored. 4- Correcting course during surgery can simplify programming and potentially improve long term outcomes . 5- Blending imaging precision w/ physiology can be powerful. https://tremorjournal.org/articles/10.5334/tohm.1098 #michaelokun #parkinson #deepbrainstimulation #fixelinstitute