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Journal of Neurosurgical Sciences 2003 March;47(1):56-60

lingua: Inglese

Do intraoperative microrecordings improve subthalamic nucleus targeting in stereotactic neurosurgery for Parkinson’s disease?

Priori A. 1, Egidi M. 1, Pesenti A. 1, Rohr M. 2, Rampini P. 1, Locatelli M. 1, Tamma F. 3, Caputo E. 3, Chiesa V. 3, Barbieri S. 1

1 Department of Neurosurgical Sciences, ­IRCCS, Ospedale Maggiore, Milan, Italy
2 Department of Bioengineering, Polytechnic, Milan, Italy
3 Department of Neurology, San Paolo Hospital, Milan, Italy


Aim. The clin­i­cal impor­tance of intra­op­er­a­tive micro­rec­ord­ings for sub­tha­lam­ic nucle­us (STN) local­iza­tion in neu­ro­sur­gi­cal prac­tice ­remains a mat­ter of ­debate in the var­i­ous ­groups.
Methods. To inves­ti­gate ­their use­ful­ness in local­iz­ing the STN, we ret­ro­spec­tive­ly eval­u­at­ed how intra­op­er­a­tive micro­elec­trode record­ings ­changed the tar­get­ing of the STN esti­mat­ed ­only on intra­op­er­a­tive stim­u­la­tion and neu­ro­an­a­tom­ic tar­get­ing pro­ce­dures. For neu­ro­ra­dio­log­ic tar­get­ing of the nucle­us we ­used a TC-MRI ­fusion algo­rithm and ­direct vis­u­al­iza­tion of the STN. Besides stan­dard micro­rec­ord­ings we ­also ana­lyzed the pow­er spec­tral den­sity (PSD) pat­tern of phys­io­log­i­cal sig­nals ­along the ­track and its neu­ro­an­a­tom­ic and clin­i­cal cor­re­la­tions.
Results. In our ­series of 12 ­patients ­with Parkinson’s dis­ease under­go­ing sur­gery for implan­ta­tion of ­deep-­brain stim­u­la­tion (DBS) elec­trodes in the STN we ­found ­that in 25% (1/4) of ­patients, micro­rec­ord­ings deter­mined the ­choice of the opti­mal ­track. In all the ­tracks ana­lyzed the PSD ­peak coin­cid­ed ­with the ­point select­ed for the ­final elec­trode implan­ta­tion on the ­basis of the stan­dard pro­ce­dure for intra­op­er­a­tive mon­i­tor­ing ­based on ­both micro­stim­u­la­tion and record­ings.
Conclusion. Intraoperative micro­rec­ord­ings are of deter­mi­nant impor­tance for accu­rate STN local­iza­tion and are essen­tial for opti­mal ­results in neu­ro­sur­gi­cal prac­tice. PSD anal­y­sis is a sim­ple and quick­ quan­ti­ta­tive sig­nal descrip­tor ­that ­will prob­ably pro­vide ­even ­more pre­cise, sim­ple and rap­id ­tool for intra­op­er­a­tive neu­ro­phys­io­log­i­cal local­iza­tion of the STN.

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