Stereotactic Targeting of the Globus Pallidus Internus in Parkinson's Disease: Imaging versus Electrophysiological Mapping

Stereotactic Targeting of the Globus Pallidus Internus in Parkinson's Disease: Imaging versus... AbstractOBJECTIVE:The reintroduction of pallidotomy for the treatment of Parkinson's disease (PD) has generated various opinions regarding the ideal anatomic or physiological location of the target within the globus pallidus. The role of microelectrode recording guidance in pallidotomy for the treatment of advanced PD is presently under debate. The purpose of this study was twofold. The first goal was to determine the degree of accuracy in the targeting of the globus pallidus internus (GPi) with magnetic resonance imaging (MRI), by comparing these results with the final placement of the thermolytic lesions (as defined by electrophysiological assessment). The second goal was to ascertain the somatotopic arrangement of the GPi in PD.METHODS:The analysis involved 50 patients with PD who underwent microrecording-guided pallidotomy. The theoretical coordinates for lesioning were calculated after definition of the intercommissural line by MRI. The actual placement of the lesions was determined after mapping of the GPi by microrecording, using stimulation to identify the sensorimotor region and its somatotopic organization.RESULTS:In most cases, the lesions were placed posterior and lateral to the targets chosen by MRI. Mapping by microrecording revealed differences of 2.3 ± 1.55 mm and 3 ± 1.9 mm in the mediolateral and anteroposterior coordinates, respectively. The actual lesion overlapped the theoretical target for only 45% of the patients. The somatotopic organization of the GPi was analyzed. Most of the units with sensorimotor activity or tremor-related activity were in the lateral portion of the nucleus. Upper limb and axial units were in the most lateral region and mainly in the ventral one-third of the nucleus. Lower limb responses were recorded mainly in the dorsal one-third of the nucleus. Tremor-related cells were found throughout the sensorimotor region of the nucleus.CONCLUSION:These results indicate that lesion targeting based on MRI alone is not sufficiently accurate to guarantee placement of the lesion in the sensorimotor region of the GPi. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Neurosurgery Oxford University Press

Stereotactic Targeting of the Globus Pallidus Internus in Parkinson's Disease: Imaging versus Electrophysiological Mapping

Stereotactic Targeting of the Globus Pallidus Internus in Parkinson's Disease: Imaging versus Electrophysiological Mapping

TECHNIQUE APPLICATIONS Stereotactic Targeting of the Globus Pallidus Internus in Parkinson's Disease: Imaging versus Electrophysiological Mapping Jorge Guridi, M.D., Ph.D., Arancha Gorospe, M.D., Eduardo Ramos, M.D., Gurutz Linazasoro, M.D., Maria C. Rodriguez, M.D., Jose Angel Obeso, M.D., Ph.D. Centro de N eurologia y N eu ro ciru g ia Fun cio n al (JG , A G , ER, G L , M C R , JA O ), C lin ic a Q u iro n , San Sebastian, and N eurosurgical D epartm ent (JG ), Hospital de N avarra, Pam p lo na, Spain O BJEC T IV E: The reintroduction of pallidotomy for the treatment of Parkinson's disease (PD ) has generated various opinions regarding the ideal anatomic or physiological location of the target within the globus pallidus. The role of microelectrode recording guidance in pallidotomy for the treatment of advanced PD is presently under debate. The purpose of this study was twofold. The first goal was to determine the degree of accuracy in the targeting of the globus pallidus internus (G Pi) with magnetic resonance imaging (M R I), by comparing these results with the final placement of the thermolytic lesions (as defined by electrophysiological assessment). The second goal was to ascertain the somatotopic arrangement of the G Pi in PD. M ETHODS: The analysis involved 50 patients with PD who underwent microrecording-guided pallidotomy. The theo­ retical coordinates for lesioning were calculated after definition of the intercommissural line by M RI. The actual placement of the lesions was determined after mapping of the GPi by microrecording, using stimulation to identify the sensorimotor region and its somatotopic organization. RESULTS: In most cases, the lesions were placed posterior and lateral to the targets chosen by M R I. Mapping by microrecording revealed differences of 2.3 ± 1.55 mm and 3 ± 1.9 mm in the mediolateral and anteroposterior coordinates, respectively. The actual lesion overlapped the theoretical target for only 4 5 % of...
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Publisher
Congress of Neurological Surgeons
Copyright
© Published by Oxford University Press.
ISSN
0148-396X
eISSN
1524-4040
D.O.I.
10.1097/00006123-199908000-00017
Publisher site
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Abstract

AbstractOBJECTIVE:The reintroduction of pallidotomy for the treatment of Parkinson's disease (PD) has generated various opinions regarding the ideal anatomic or physiological location of the target within the globus pallidus. The role of microelectrode recording guidance in pallidotomy for the treatment of advanced PD is presently under debate. The purpose of this study was twofold. The first goal was to determine the degree of accuracy in the targeting of the globus pallidus internus (GPi) with magnetic resonance imaging (MRI), by comparing these results with the final placement of the thermolytic lesions (as defined by electrophysiological assessment). The second goal was to ascertain the somatotopic arrangement of the GPi in PD.METHODS:The analysis involved 50 patients with PD who underwent microrecording-guided pallidotomy. The theoretical coordinates for lesioning were calculated after definition of the intercommissural line by MRI. The actual placement of the lesions was determined after mapping of the GPi by microrecording, using stimulation to identify the sensorimotor region and its somatotopic organization.RESULTS:In most cases, the lesions were placed posterior and lateral to the targets chosen by MRI. Mapping by microrecording revealed differences of 2.3 ± 1.55 mm and 3 ± 1.9 mm in the mediolateral and anteroposterior coordinates, respectively. The actual lesion overlapped the theoretical target for only 45% of the patients. The somatotopic organization of the GPi was analyzed. Most of the units with sensorimotor activity or tremor-related activity were in the lateral portion of the nucleus. Upper limb and axial units were in the most lateral region and mainly in the ventral one-third of the nucleus. Lower limb responses were recorded mainly in the dorsal one-third of the nucleus. Tremor-related cells were found throughout the sensorimotor region of the nucleus.CONCLUSION:These results indicate that lesion targeting based on MRI alone is not sufficiently accurate to guarantee placement of the lesion in the sensorimotor region of the GPi.

Journal

NeurosurgeryOxford University Press

Published: Aug 1, 1999

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