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A Journal on Neurosurgery

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Journal of Neurosurgical Sciences 2003 March;47(1):18-25

language: English

Different methods for anatomical targeting

Iacopino D. G., Conti A., Angileri F. F., Tomasello F.

Neurosurgical Clinic, University of Messina, Messina, Italy


Aim. Several pro­ce­dures are ­used in the dif­fer­ent neu­ro­sur­gi­cal cen­ters in ­order to per­form ster­eo­tac­tic sur­gery for move­ment dis­or­ders. At the ­moment no pro­ce­dure can real­ly be con­sid­ered super­i­or to the oth­er. We con­trib­ute ­with our expe­ri­ence of tar­get­ing meth­od.
Methods. Ten ­patients ­were select­ed, in accor­dance to the guide­lines for the treat­ment of Parkinson dis­ease, and oper­at­ed by sev­er­al meth­ods includ­ing pal­li­dot­o­my, bilat­er­al inser­tion of chron­ic ­deep ­brain elec­trodes with­in the inter­nal pal­lid­um and in the sub­tha­lam­ic nucle­us (18 pro­ce­dures). Interventions: in ­each ­patient an MR ­scan was per­formed the day ­before sur­gery. Scans ­were per­formed axial­ly par­allel to the inter­com­mis­su­ral ­line. The oper­at­ing day a con­trast CT ­scan was per­formed ­under ster­eo­tac­tic con­di­tions. Measures: ­after dig­i­tal­iza­tion of the MRI imag­es, it was pos­sible to vis­u­al­ize the sur­gi­cal tar­get and to ­relate it to paren­chi­mal and vas­cu­lar ana­tom­ic struc­tures read­able at the CT exam­ina­tion. The CT ­scan ­obtained was con­front­ed ­with the MR pre­vi­ous­ly per­formed, the geo­met­ri­cal rela­tion ­between the dif­fer­ent paren­chi­mal and vas­cu­lar struc­tures and the select­ed ­targets were ­obtained. Stereotactic coor­di­nates ­were ­obtained on the CT exam­ina­tion.
Results. It was pos­sible to cal­cu­late the posi­tion of the sub­tha­lam­ic nucle­us and of the inter­nal pal­lid­um on the CT ­scan, not ­only relat­ing to the inter­com­mis­su­ral ­line, but con­sid­er­ing ­also the neu­ro­vas­cu­lar struc­tures dis­played ­both on the MRI and the CT ­scans.
Conclusion. The tech­nique ­that our ­group ­presents con­sist in an inte­gra­tion ­between infor­ma­tion ­derived ­from the CT and the MR tech­niques, so ­that we can ben­e­fit ­from the advan­tag­es of ­both meth­ods and over­come the dis­ad­van­tag­es.

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