ORIGINAL ARTICLES  PARKINSON’S DISEASE 

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

Copyright © 2004 EDIZIONI MINERVA MEDICA

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.