Microelectrode Recording during Posteroventral Pallidotomy: Impact on Target Selection and Complications

Microelectrode Recording during Posteroventral Pallidotomy: Impact on Target Selection and... AbstractOBJECTIVE:To assess the practical usefulness of single-cell microelectrode recording (MER) when performing posteroventral pallidotomy.METHODS:A retrospective comparison of the initial, magnetic resonance imaging-derived coordinates of the pallidotomy target to the final, MER-refined lesion coordinates in 132 consecutive pallidotomies was conducted. The time required to perform the procedure and the surgical complications are reported.RESULTS:MER led to targeting changes in 98% of the cases. In 12%, the MER-refined target was more than 4 mm from the original, image-guided site, which is a targeting error that could adversely affect outcome. Although all components of targeting were affected by MER, laterality and depth were impacted most. The ventral border of the globus pallidus pars interna was located within 1 mm of the magnetic resonance imaging-selected target in only 40% of the cases. On average, only 2.2 MER trajectories were required to perform pallidotomy. During the last 3 years of our study, 85% of the procedures were performed with one or two trajectories. The mean operating time of the operations performed during the last 3 years was 2 hours and 12 minutes. The incidence of intracerebral hemorrhage in our series (1.5%) was no higher than that reported for other large series of stereotactic procedures. No patient suffered an optic tract injury.CONCLUSION:MER provides important targeting information for performing pallidotomy. In particular, the micrometric delineation of the ventral border of the globus pallidus pars interna permits safe lesioning of the posteroventral region of the globus pallidus pars interna with little risk of visual field deficit. These data can be obtained efficiently and without increased surgical risk. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Neurosurgery Oxford University Press

Microelectrode Recording during Posteroventral Pallidotomy: Impact on Target Selection and Complications

Microelectrode Recording during Posteroventral Pallidotomy: Impact on Target Selection and Complications

Microelectrode Recording during Posteroventral Pallidotomy: Impact on Target Selection and Complications Ron L. Alterman, M .D ., Djordje Sterio, M .D ., D.Sc., Aleksandar Beric, M .D ., D.Sc., Patrick J. Kelly, M .D. N ew York U niversity Center for the Study and Treatment of M ovement Disorders (D S, A B , PK) and The Institute for Neurology and Neurosurgery (RLA), Beth Israel M edical Center, North D ivisio n , N ew York, N ew York OBJECTIVE: To assess the practical usefulness of single-cell m icroelectrode recording (M ER ) when performing posteroventral pallidotomy. METHODS: A retrospective comparison of the initial, magnetic resonance imaging-derived coordinates of the pallidotomy target to the final, MER-refined lesion coordinates in 132 consecutive pallidotomies was conducted. The time required to perform the procedure and the surgical complications are reported. RESULTS: M ER led to targeting changes in 9 8 % of the cases. In 1 2 % , the MER-refined target was more than 4 mm from the original, image-guided site, w hich is a targeting error that could adversely affect outcome. Although all components of targeting w ere affected by M ER, laterality and depth were impacted most. The ventral border of the globus pallidus pars interna was located w ithin 1 mm of the magnetic resonance imaging-selected target in only 4 0 % of the cases. O n average, only 2.2 M ER trajectories were required to perform pallidotomy. During the last 3 years of our study, 8 5 % of the procedures were performed with one or two trajectories. The mean operating time of the operations performed during the last 3 years was 2 hours and 12 minutes. The incidence of intracerebral hemorrhage in our series (1 .5 % ) was no higher than that reported for other large series of stereotactic procedures. No patient suffered an optic tract injury. C O N C LU SIO N : M ER provides important targeting information for performing pallidotomy. In particular, the micrometric delineation of the ventral...
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Publisher
Congress of Neurological Surgeons
Copyright
© Published by Oxford University Press.
ISSN
0148-396X
eISSN
1524-4040
D.O.I.
10.1097/00006123-199902000-00036
Publisher site
See Article on Publisher Site

Abstract

AbstractOBJECTIVE:To assess the practical usefulness of single-cell microelectrode recording (MER) when performing posteroventral pallidotomy.METHODS:A retrospective comparison of the initial, magnetic resonance imaging-derived coordinates of the pallidotomy target to the final, MER-refined lesion coordinates in 132 consecutive pallidotomies was conducted. The time required to perform the procedure and the surgical complications are reported.RESULTS:MER led to targeting changes in 98% of the cases. In 12%, the MER-refined target was more than 4 mm from the original, image-guided site, which is a targeting error that could adversely affect outcome. Although all components of targeting were affected by MER, laterality and depth were impacted most. The ventral border of the globus pallidus pars interna was located within 1 mm of the magnetic resonance imaging-selected target in only 40% of the cases. On average, only 2.2 MER trajectories were required to perform pallidotomy. During the last 3 years of our study, 85% of the procedures were performed with one or two trajectories. The mean operating time of the operations performed during the last 3 years was 2 hours and 12 minutes. The incidence of intracerebral hemorrhage in our series (1.5%) was no higher than that reported for other large series of stereotactic procedures. No patient suffered an optic tract injury.CONCLUSION:MER provides important targeting information for performing pallidotomy. In particular, the micrometric delineation of the ventral border of the globus pallidus pars interna permits safe lesioning of the posteroventral region of the globus pallidus pars interna with little risk of visual field deficit. These data can be obtained efficiently and without increased surgical risk.

Journal

NeurosurgeryOxford University Press

Published: Feb 1, 1999

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