Pallidotomy Lesion Locations: Significance of Microelectrode Refinement

Pallidotomy Lesion Locations: Significance of Microelectrode Refinement AbstractOBJECTIVE:To determine whether stereotactic pallidotomy requires refinement using microelectrode recording to ensure proper lesion placement.METHODS:The experiment approach was based on retrospective comparisons of microelectrode-refined radiofrequency lesion locations with hypothetical unrefined lesion positions. Actual and hypothetical pallidotomy lesions were classified based on their lesion center (thermocoagulative zone) locations and their total lesion areas (surrounding edematous zone) relative to the pallidal target. Assessments were made using postoperative T2-weighted magnetic resonance axial images, which showed both the lesion and globus pallidus (CP). The magnitude of microelectrode refinement from an initial preoperative starting point determined by computed tomography was calculated using stereotactic coordinates and included corrections for the lesioning tract trajectory angle.RESULTS:In all 25 patients, the center of the actual pallidotomy lesion was within the GP. Without microelectrode refinement, 13 of 25 hypothetical lesion positions would have been localized such that the lesion center would not have remained in the GP. In eight cases, microelectrode refinement resulted in no significant change in lesion location, but in one case, microelectrode refinement resulted in lesion center placement away from the GP.CONCLUSION:Kinesthetically driven microelectrode refinement in pallidotomy lesioning seems to be required to ensure proper lesion location within the GP. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Neurosurgery Oxford University Press

Pallidotomy Lesion Locations: Significance of Microelectrode Refinement

Pallidotomy Lesion Locations: Significance of Microelectrode Refinement

T E C H N IQ U E A P P L IC A T IO N S Pallidotomy Lesion Locations: Significance of Microelectrode Refinement Kuojen Tsao, M.D., Steve W ilkinson, M.D., John Overman, B.S., W illiam C. Koller, M.D., Ph.D., Solomon Batnitzky, M.D., Michael A. Gordon, Ph.D. Imaging Resource Center (KJT, SW, JO, M A C), Department of Surgery, Division of Neurosurgery (SW, JO), and Departments of Neurology (W CK), Radiology (SB), and Pharmacology, Toxicology and Therapeutics (MAG), University of Kansas Medical Center, Kansas City, Kansas O B JE C T IV E : To determine whether stereotactic pallidotomy requires refinement using m icroelectrode recording to ensure proper lesion placement. M E T H O D S : The experiment approach was based on retrospective comparisons of microelectrode-refined radiofre­ quency lesion locations with hypothetical unrefined lesion positions. Actual and hypothetical pallidotomy lesions were classified based on their lesion center (thermocoagulative zone) locations and their total lesion areas (surrounding edematous zone) relative to the pallidal target. Assessments were made using postoperative T2-weighted magnetic resonance axial images, which showed both the lesion and globus pallidus (CP). The magnitude of microelectrode refinement from an initial preoperative starting point determined by computed tomography was calculated using stereotactic coordinates and included corrections for the lesioning tract trajectory angle. RESULTS: In all 25 patients, the center of the actual pallidotomy lesion was within the GP. Without microelectrode refinement, 13 of 25 hypothetical lesion positions would have been localized such that the lesion center would not have remained in the GP. In eight cases, microelectrode refinement resulted in no significant change in lesion location, but in one case, microelectrode refinement resulted in lesion center placement away from the GP. C O N C L U S IO N : Kinesthetically driven microelectrode refinement in pallidotomy lesioning...
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Publisher
Oxford University Press
Copyright
© Published by Oxford University Press.
ISSN
0148-396X
eISSN
1524-4040
D.O.I.
10.1097/00006123-199809000-00061
Publisher site
See Article on Publisher Site

Abstract

AbstractOBJECTIVE:To determine whether stereotactic pallidotomy requires refinement using microelectrode recording to ensure proper lesion placement.METHODS:The experiment approach was based on retrospective comparisons of microelectrode-refined radiofrequency lesion locations with hypothetical unrefined lesion positions. Actual and hypothetical pallidotomy lesions were classified based on their lesion center (thermocoagulative zone) locations and their total lesion areas (surrounding edematous zone) relative to the pallidal target. Assessments were made using postoperative T2-weighted magnetic resonance axial images, which showed both the lesion and globus pallidus (CP). The magnitude of microelectrode refinement from an initial preoperative starting point determined by computed tomography was calculated using stereotactic coordinates and included corrections for the lesioning tract trajectory angle.RESULTS:In all 25 patients, the center of the actual pallidotomy lesion was within the GP. Without microelectrode refinement, 13 of 25 hypothetical lesion positions would have been localized such that the lesion center would not have remained in the GP. In eight cases, microelectrode refinement resulted in no significant change in lesion location, but in one case, microelectrode refinement resulted in lesion center placement away from the GP.CONCLUSION:Kinesthetically driven microelectrode refinement in pallidotomy lesioning seems to be required to ensure proper lesion location within the GP.

Journal

NeurosurgeryOxford University Press

Published: Sep 1, 1998

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