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

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.