Staged Versus Simultaneous Bilateral Deep Brain Stimulation: A Matched Comparison of Outcomes and Resource Utilization

Austin M Hilvert; Sameer Sundrani; Clayton R Baker; Astoria Chao; Jordan Vanleuven; Emma Ye; Natasha Hughes; Isabel Long; Sharonya Battula; Rui Li; Robert Shults; Benoit M Dawant; Tyler Ball; Travis Hassell; Dario J Englot; Sarah K Bick

doi:10.1227/neu.0000000000003893

Staged Versus Simultaneous Bilateral Deep Brain Stimulation: A Matched Comparison of Outcomes and Resource Utilization

Neurosurgery. 2026 Jan 8. doi: 10.1227/neu.0000000000003893. Online ahead of print.

Authors

Austin M Hilvert¹, Sameer Sundrani¹, Clayton R Baker¹, Astoria Chao¹, Jordan Vanleuven¹, Emma Ye¹, Natasha Hughes¹, Isabel Long¹, Sharonya Battula¹, Rui Li², Robert Shults², Benoit M Dawant^{2

3}, Tyler Ball¹, Travis Hassell¹, Dario J Englot^{1

4}, Sarah K Bick^{1

4

5}

Affiliations

¹ Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
² Vanderbilt Institute for Surgery and Engineering, Vanderbilt University, Nashville, Tennessee, USA.
³ Department of Electrical and Computer Engineering, Vanderbilt University, Nashville, Tennessee, USA.
⁴ Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee, USA.
⁵ Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA.

PMID: 41504434
DOI: 10.1227/neu.0000000000003893

Abstract

Background and objectives: Deep brain stimulation (DBS) is a widely used treatment for movement disorders. While bilateral implantation is common, whether to implant electrodes in separate (staged) procedures or in a single (simultaneous) session remains debated.

Methods: In this retrospective matched cohort study, 252 patients who underwent staged bilateral DBS were propensity matched to 252 who underwent simultaneous procedures (n = 504) based on age, sex, and diagnosis. Demographic, clinical, and operative data were extracted from the electronic medical record.

Results: Staged patients were older (71.7 ± 6.4 vs 65.6 ± 6.9 years, P < .0001) and had lower body mass index (27.4 ± 5.4 vs 29.1 ± 6.5 kg/m2, P = .003). Parkinson's disease predominated in staged cases (54%) and essential tremor in simultaneous (69%) (P < .001); dystonia was rare and similarly distributed (P = .261). DBS targets differed: subthalamic nucleus and globus pallidus internus were more common in staged cases and ventral intermediate nucleus in simultaneous (P < .0001). Sex, race, American Society of Anesthesiologists status classification system scores, and major comorbidities were similar (P > .05). Staged DBS was associated with greater anesthesia utilization, operating room time, and hospital days (all P < .0001). After adjustment for covariates, there were no significant differences in intraoperative complications, postoperative complications, postoperative delirium, 30-day readmissions, medication dose reduction at 1 year, or reoperation within 5 years (odds ratios 0.81-1.44, all P > .5).

Conclusion: Staged and simultaneous bilateral DBS yield similar clinical outcomes; however, staged procedures require significantly greater resource utilization and subject patients to a more prolonged treatment course.

Keywords: Deep brain stimulation; Economics; Efficiency; Essential tremor; Movement disorders; Parkinson disease; Resource utilization.