Electrocorticography During Deep Brain Stimulation Surgery for Movement Disorders: Single-Center Experience

Abstract Background Electrocorticography (ECoG) can be used as an intraoperative research tool during deep brain stimulation (DBS) implantation procedures. Its application has contributed to understanding the neurophysiology of movement disorders and the therapeutic effects of DBS. The aim of this report is to demonstrate the feasibility, safety, and utility of high-density ECoG for acquiring high-resolution neurophysiological data during DBS surgery. Methods Data were obtained from patients undergoing awake DBS surgery for the treatment of Parkinson’s disease (PD) or essential tremor (ET) at Johns Hopkins Hospital between February 2021 and September 2024. Burr holes created for the DBS lead implantation were used for ECoG strip placement. Electrophysiological and anatomical data were analyzed using MATLAB FieldTrip and Freesurfer, with localization in the anterior commissure and posterior commissure (ACPC) and Montreal Neurological Institute (MNI) coordinate systems. Surgical complications were monitored for at least six months postoperatively. Results Thirty-six patients (26 PD, 10 ET) were enrolled in the study. In one case, anatomical placement was inadequate for neurophysiological analysis. Postoperative complications included three infections (8.3%) and one chronic subdural hematoma (2.8%), with no permanent neurological deficits. The total complication rate was 11.1%, and all complications were unlikely to be related to ECoG strip placement. Anatomical and neurophysiological analysis demonstrated high-resolution cortical mapping. Multiple-subject level analysis using high-density ECoG yielded over 1,300 electrode positions. Conclusion ECoG during DBS is a valuable research method for movement disorders without additional risk to the standard procedure. The use of high-density intraoperative ECoG grids and the analysis of multiple-subject data in a standardized anatomical mapping space allows for high-resolution neurophysiological data acquisition and analysis.