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Subthalamic Nucleus Deep Brain Stimulation: An Invaluable Role for MER

Published online by Cambridge University Press:  23 September 2014

F. A. Zeiler ,
M. Wilkinson  and
J. P. Krcek
F. A. Zeiler*
Affiliation:
Department of Surgery, Section of Neurosurgery, University of Manitoba, Winnipeg, Manitoba, Canada
M. Wilkinson
Affiliation:
Department of Surgery, Section of Neurosurgery, University of Manitoba, Winnipeg, Manitoba, Canada
J. P. Krcek
Affiliation:
Department of Surgery, Section of Neurosurgery, University of Manitoba, Winnipeg, Manitoba, Canada
*
Section of Neurosurgery, University of Manitoba, GB-1 820 Sherbrook Street, Health Sciences Center, Winnipeg, Manitoba, R3A 1R9, Canada. Email: umzeiler@cc.umanitoba.ca
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Abstract:

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Introduction:

Subthalamic nucleus (STN) deep brain stimulation (DBS) is currently the main surgical procedure for medically refractory Parkinson's disease. The benefit of intra-operative microelectrode recording (MER) for the purpose of neurophysiological localization and mapping of the STN continues to be debated.

Methods:

A retrospective review of the charts and operative reports of all patients receiving STN DBS implantation for Parkinson's disease at our institution from January 2004 to March 2011 was done.

Results:

Data from 43 of 44 patients with Parkinson's disease treated with STN DBS were reviewed. The average number of tracts on the left was 2.4, versus 2.3 on the right. The average dorsal and ventral anatomical boundaries of the STN based on Schaltenbrand's Stereotactic Atlas were estimated to be at -5.0 mm above and +1.4 mm below target respectively. The average dorsal and ventral boundaries of the STN using MER were -2.6 mm above and +2.0 mm below target respectively. The average dorsal-ventral distance of the STN as predicted by Stereotactic Atlas was 6.4 mm, compared to 4.6 mm as determined by MER. MER demonstrated the average dorsal and ventral boundaries on the left side were -2.6 mm and +2.2 mm from target respectively, while the average dorsal and ventral boundaries on the right side were -2.5 mm and +1.8 mm from target respectively with MER.

Conclusions:

MER in STN DBS surgery demonstrated measurable difference between stereotactic atlas/MRI STN target and neurophysiologic STN localization.

Résumé:

RÉsumÉ:Contexte:

La stimulation cérébrale profonde (SCP) du corps de Luys (CL) est actuellement la principale intervention chirurgicale utilisée dans le traitement de la maladie de Parkinson réfractaire au traitement médical. Le bénéfice de l'enregistrement par microélectrode (MER) pendant la chirurgie pour la localisation neurophysiologique et la cartographie du CL demeure un sujet de controverse.

Méthode:

Nous avons effectué une revue rétrospective des dossiers et des comptes rendus chirurgicaux de tous les patients atteints de la maladie de Parkinson qui ont reçu une implantation d'électrode pour la SCP du CL dans notre institution de janvier 2004 à mars 2011.

Résultats:

Les données de 43 des 44 patients atteints de la maladie de Parkinson traités par SCP du CL ont été revues. Le nombre moyen de faisceaux était 2,4 du côté gauche et 2,3 du côté droit. Les limites anatomiques dorsales et ventrales moyennes du CL selon l'atlas d'anatomie stéréotaxique de Schaltenbrand se situaient à -5,0 mm au dessus et +1,4 mm sous la cible respectivement selon notre estimé. Les limites dorsales et ventrales moyennes du CL en utilisant le MER étaient -2,6 mm au dessus et +2,0 mm sous la cible respectivement. La distance dorsale-ventrale moyenne du CL prédite au moyen de l'atlas était 6,4 mm comparée à 4,6 mm selon la détermination par le MER. Le MER a montré que les limites dorsales et ventrales moyennes du côté gauche étaient à -2,6 mm et +2,2 mm de la cible respectivement, alors que les limites dorsales et ventrales moyennes du côté droit étaient à -2,5 mm et +1,8mm de la cible respectivement avec le MER.

Conclusions:

Le MER dans chirurgie de la SCP du CL a montré une différence mesurable entre la cible au niveau du CL telle que déterminée selon l'atlas d'anatomie stéréotaxique/l'IRM et la localisation neurophysiologique par SCP.

Type
Research Article
Information
Canadian Journal of Neurological Sciences , Volume 40 , Issue 4 , July 2013 , pp. 572 - 575
Copyright
Copyright © The Canadian Journal of Neurological 2013

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