{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T11:08:44Z","timestamp":1789211324493,"version":"build-2803163510"},"posted":{"date-parts":[[2025,9,28]]},"group-title":"Neurology","reference-count":30,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2025,9,28]],"date-time":"2025-09-28T00:00:00Z","timestamp":1759017600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2026,9,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                <jats:sec>\n                  <jats:title>Background and Objectives<\/jats:title>\n                  <jats:p>Advances in neuroimaging and stereotactic accuracy have led many centers to adopt asleep workflows for deep brain stimulation (DBS), raising questions about the continued role of awake surgery with microelectrode recording (MER). We evaluated whether intraoperative physiologic testing during awake ventral intermediate nucleus (Vim) DBS results in trajectory adjustments that converge with the imaging-defined target.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We retrospectively reviewed 137 consecutive Vim DBS leads implanted in awake patients. For each lead, we determined whether the final implant followed the planned trajectory, required a depth adjustment, or was moved to a parallel trajectory based on MER and test stimulation. In cases involving parallel trajectory adjustments, co-registered preoperative imaging and postoperative CT were used to compare the final lead position with the imaging-defined target and determine the direction and magnitude of deviation. Intraoperative ring stimulation data were analyzed to compare tremor suppression and side effects before and after trajectory adjustment.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Of 137 leads, 116 (85%) were implanted along the planned trajectory, including 49 at the planned depth and 67 with depth adjustments. Twenty-one leads (15%) were moved to a parallel trajectory based on intraoperative findings; 17 had data suitable for spatial analysis. Among these, 13 (76%) were moved farther from the imaging-defined target, 2 (12%) an equal distance across the target, and 2 (12%) closer. In 12 cases with paired pre- and post-adjustment stimulation testing, trajectory adjustment was associated with reduced stimulation required for near tremor resolution, increased side-effect thresholds, and expansion of the therapeutic window. No leads required revision.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Intraoperative physiologic testing during awake Vim DBS frequently prompted trajectory adjustments that would not have been made under imaging guidance alone and were associated with improved stimulation response, underscoring the continuing role of awake testing in refining lead placement to patient-specific functional anatomy.<\/jats:p>\n                <\/jats:sec>","DOI":"10.1101\/2025.09.25.25336654","type":"posted-content","created":{"date-parts":[[2025,9,28]],"date-time":"2025-09-28T17:55:12Z","timestamp":1759082112000},"source":"Crossref","is-referenced-by-count":0,"title":["The Modern Utility of Awake Deep Brain Stimulation Surgery"],"prefix":"10.64898","author":[{"given":"Bryan T.","family":"Klassen","sequence":"first","affiliation":[{"name":"Department of Neurology, Mayo Clinic, Rochester, MN, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew R.","family":"Baker","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kai J.","family":"Miller","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"54368","reference":[{"key":"2026091204000568000_2025.09.25.25336654v2.1","doi-asserted-by":"publisher","DOI":"10.1159\/000100803"},{"key":"2026091204000568000_2025.09.25.25336654v2.2","doi-asserted-by":"publisher","DOI":"10.1126\/science.106.2754.349"},{"key":"2026091204000568000_2025.09.25.25336654v2.3","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(95)90062-4"},{"key":"2026091204000568000_2025.09.25.25336654v2.4","doi-asserted-by":"publisher","DOI":"10.3171\/jns.2002.97.2.0370"},{"key":"2026091204000568000_2025.09.25.25336654v2.5","doi-asserted-by":"publisher","DOI":"10.1097\/00001756-199407000-00031"},{"issue":"2","key":"2026091204000568000_2025.09.25.25336654v2.6","doi-asserted-by":"crossref","first-page":"246","DOI":"10.1001\/jamaneurol.2017.3129","article-title":"A review of the current therapies, challenges, and future directions of transcranial focused ultrasound technology: advances in diagnosis and treatment","volume":"75","year":"2018","journal-title":"JAMA neurology"},{"key":"2026091204000568000_2025.09.25.25336654v2.7","doi-asserted-by":"publisher","DOI":"10.1016\/j.neuroimage.2014.12.002"},{"key":"2026091204000568000_2025.09.25.25336654v2.8","unstructured":"Jensen MA , Neimat JS , Kerezoudis P , Ali R , Richardson RM , Halpern CH , et al. 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