Abstract: Objective To study the safety of deep brain stimulation surgery (DBS) in the elderly patients with Parkinson’s disease receiving different surgical strategies by simulating the puncture of DBS through the operation planning workstation. Methods The clinical data of 254 elderly patients with Parkinson’s disease aged ≥65 years who underwent DBS in the First Affiliated Hospital of Nanjing Medical University from 2014 to 2023 were retrospectively analyzed. The images of the patients were transfered to the operation planning workstation. Each case used the traditional surgical puncture strategy (control group) and the customized puncture strategy (customized group) respectively to simulate the surgical puncture with the subthalamic nucleus (STN) and the lateral part of the globus pallidus (GPI) as the targets. The incidence of puncture needle path through the common high-risk anatomical structures in the brain was recorded and compared between the two groups. Results A total of 254 patients underwent simulated surgical puncture on both sides, with a total of 508 needle paths. With the STN nucleus as the puncture target, the proportion of the needle path passing through the high-risk anatomical structure in the customized group was much less than that in the control group (1.38% vs 28.94%, P<0.05); When the GPI nucleus was used as the target for puncture, the proportion of the needle path passing through the high-risk anatomical structure in the customized group was much less than that in the control group (0.98% vs 25.20%, P<0.05). Conclusions Using the operation planning system to formulate the individualized puncture path can greatly reduce the risk of puncture to the abnormal anatomical structure, reduce the bleeding complications at the puncture site, and improve the safety of the operation.

Key words: deep brain stimulation, Parkinson’s disease, puncture needle path, surgical planning system