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ORIGINAL ARTICLES  PARKINSON’S DISEASE


Journal of Neurosurgical Sciences 2003 March;47(1):33-9

Copyright © 2004 EDIZIONI MINERVA MEDICA

lingua: Inglese

Multiple sequential image-fusion and direct MRI localisation of the subthalamic nucleus for deep brain stimulation

Rampini P. M. 1, Locatelli M. 1, Alimehmeti R. 1, Tamma F. 2, Caputo E. 2, Priori A. 3, Pesenti A. 3, Rohr M. 4, Egidi M. 1

1 Neurosurgical Operative Unit, Department of Neurological Sciences, IRCCS Maggiore Polyclinic Hospital, University of Milan, Milan, Italy, 2 Neurological Operative Unit, Department of Neurological Sciences, IRCCS Maggiore Polyclinic Hospital, University of Milan, Milan, Italy, 3 Neurological Clinic, S. Paolo Hospital, Milan, Italy, 4 Department of Bioengeneering, Polytechnic, Milan, Italy


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Aim. Deep ­brain stim­u­la­tion (DBS) is the treat­ment of ­choice for ­advanced Parkinson’s disease. The tar­get co-ordi­nates are tra­di­tion­al­ly cal­cu­lat­ed in rela­tion to the inter­com­mis­su­ral dis­tance. Anterior (AC) and pos­te­ri­or com­mis­sures (PC) may be visu­al­ised by the ­means of ven­tric­u­log­ra­phy, CT or MRI.
Methods. We ­have stud­ied the effi­ca­cy of ­direct vis­u­al­isa­tion of the sub­tha­lam­ic-red nucle­us com­plex on MRI, the advan­tage of ­fusion of ster­eo­tac­tic CT and MR imag­es (Multiple Sequences Image Fusion - MuSIF). These meth­ods are com­bined ­with dou­ble ­check of indi­rect cal­cu­la­tion of the tar­get co-ordi­nates ­based on AC-PC ­line, as ­well as the cor­ris­pon­dence to the ster­eo­tac­tic elec­tron­ic ­atlas.
Results. Subthalamic nucleus (STN) was ­well rec­og­nis­able in ­fused imag­es in all 22 ­sides. At 3 ­months ­from sur­gery it was pos­sible to ­reduce 76% of L-­dopa equiv­a­lent dai­ly ­dose. Dyskine-­sias ­reduced to 50% and ­motor fluc­tu­a­tion up to 45%.
Conclusion. In our expe­ri­ence MuSIF ­offers ­very ­high ­rate of accu­ra­cy in cal­cu­la­tion of tar­get co-ordi­nates. Direct vis­u­al­isa­tion of STN in MR and MuSIF are reli­able and facil­i­tate the accu­ra­cy of iden­tifi­ca­tion of tar­get co-ordi­nates. Intraoperative neu­ro­phys­io­log­i­cal record­ing increas­es the accu­ra­cy of micro­elec­trode posi­tion.

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