BACKGROUND Microelectrode recording (MER) and intraoperative magnetic resonance imaging (iMRI) have been used in deep brain stimulation surgery for Parkinson disease (PD), but comparative methodology is lacking. Therefore, we compared the 1-year follow-up outcomes of MER-guided and iMRI-guided subthalamic nucleus (STN) deep brain stimulation (DBS) surgery in PD patients. METHODS We conducted a review comparing PD patients who underwent MER-guided (n = 76, group A) and iMRI-guided STN DBS surgery (n = 61, group B) in our institution. Pre- and postoperative assessments included Unified Parkinson's Disease Rating Scale-III (UPDRS-III) score, Parkinson's Disease Questionnaire (PDQ-39), Mini-Mental State Examination (MMSE), levodopa equivalent daily doses (LEDDs), and magnetic resonance images. RESULTS The mean magnitudes of electrode discrepancy were x = 1.1 ± 0.2 mm, y = 1.3 ± 0.3 mm, and z = 2.1 ± 0.5 mm in group A and x = 1.3 ± 0.4 mm, y = 1.2 ± 0.2 mm, and z = 2.5 ± 0.7 mm in group B. Significant differences were not found between 2 groups for x, y, or z (P = 0.34, P = 0.26, and P = 0.41, respectively). At 1 year, when levodopa was withdrawn for 12 hours, the UPDRS-III score improved by 66.3% ± 13.5% in group A and 64.8% ± 12.7% in group B (P = 0.24); the PDQ-39 summary index score improved by 49.7% ± 14.3% in group A and 44.1% ± 12.7% in group B (P = 0.16); the MMSE score improved by 4.2% ± 2.1% in group A and 11.1% ± 3.2% in group B (P = 0.43); and LEDDs decreased by 48.7% ± 10.1% in group A and 56.9% ± 12.0% in group B (P = 0.32). CONCLUSIONS MER and iMRI both are effective ways to ensure adequate electrode placement in DBS surgery, but there is no superiority between both techniques, at least in terms of 1-year follow-up outcomes.