ORIGINAL ARTICLES  PARKINSON’S DISEASE 

Journal of Neurosurgical Sciences 2003 March;47(1):26-32

Copyright © 2004 EDIZIONI MINERVA MEDICA

lingua: Inglese

MRI indirect stereotactic targeting for deep brain stimulation in Parkinson’s disease

Landi A. ¹, Grimaldi M. ², Antonini A. ⁴, Parolin M. ¹, Zincone A. ³, Marina R. ², De Grandi C. ², Sganzerla E. P. ¹, Gaini S. M. ¹

¹ Department of Neurosurgery University of Milano-Bicocca S. Gerardo Hospital, Monza (MI), Italy 2 Department of Neuroradiology University of Milano-Bicocca S. Gerardo Hospital, Monza (MI), Italy 3 Department of Neurology University of Milano-Bicocca S. Gerardo Hospital, Monza (MI), Italy 4 Parkinson’s Center CTO-ICP, Milan, Italy

Aim. Stereotactic local­isa­tion of ­brain tar­gets for func­tion­al neu­ro­sur­gery ­might be ­obtained ­with dif­fer­ent neu­ro­im­ag­ing sourc­es. Magnetic res­o­nance (MR) ­might be of par­tic­u­lar inter­est for its ­high def­i­ni­tion of the var­i­ous ­brain struc­tures; unfor­tu­nate­ly, mag­net­ic ­field dis­tor­tion and inac­cu­ra­cy in imag­ing repro­duc­tion con­strain the use of MRI in ster­eo­tac­tic sur­gery.
Methods. We ­present an experi­men­tal ­work devot­ed to the util­iza­tion of MRI in the tar­get­ing of the sub­tha­lam­ic nucle­us for ­deep ­brain stim­u­la­tion (DBS) in Par­kin­so­nian ­patients.
Results. Experimental ­data ­were ­obtained ­after PVC phan­tom and ­fixed ­human ­brain meas­ure­ments of the ster­eo­tac­tic coor­di­nates of spe­cif­ic ­basal gan­glia struc­tures. Intrinsic and exter­nal sourc­es of ­error and imag­ing dis­tor­tion ­have ­been care­ful­ly cor­rect­ed. Afterwards, 36 ­patients, oper­at­ed for DBS in the sub­thal­a­mus for Parkinson’s disease (PD), ­have ­been inves­ti­gat­ed. MRI tar­get­ing ­proved to be clin­i­cal­ly suc­cess­ful; com­par­ing ana­tom­i­cal and neu­ro­phys­io­log­i­cal find­ings, MRI tar­get­ing scat­tered ­from the neu­ro­phys­io­log­i­cal tar­get­ing in a minor­ity of cas­es.
Conclusion. MRI tar­get­ing ­proved to be reli­able for func­tion­al ster­eo­tac­tic sur­gery, pend­ing care­ful and ade­quate qual­ity con­trol of the dis­tor­tion and of the sourc­es of ­error.