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Long-term experience with intraoperative microrecording during DBS neurosurgery in STN and GPi.

Bour LJ, Contarino MF, Foncke EM, de Bie RM, van den Munckhof P, Speelman JD, Schuurman PR - Acta Neurochir (Wien) (2010)

Bottom Line: The mean and standard deviation of the deepest contact point with respect to the magnetic resonance imaging (MRI)-based target for the STN was 2.1 ± 1.5 mm and for the GPi was -0.5 ± 1.2 mm.On average, the target as defined by MER activity intensity was in accordance with the MRI-based targets both for the STN and GPi.However, the position of the best MER activity did not necessarily correlate with the locus that produced the most beneficial clinical response on macroelectrode testing intraoperatively.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology/Clinical Neurophysiology, University of Amsterdam, The Netherlands. bour@amc.nl

ABSTRACT

Background: Intraoperative microelectrode recording (MER) for targeting during deep brain stimulation (DBS) procedures has been evaluated over a period of 4 years, in 57 consecutive patients with Parkinson's disease, who received DBS in the subthalamic nucleus (STN-DBS), and 28 consecutive patients with either dystonia (23) or Parkinson's disease (five), in whom the internal segment of the globus pallidus (GPi-DBS) was targeted.

Methods: The procedure for DBS was a one-stage bilateral stereotactic approach using a combined electrode for both MER and macrostimulation. Up to five micro/macro-electrodes were used in an array with a central, lateral, medial, anterior, and posterior position. Final target location was based on intraoperative test stimulation.

Findings: For the STN, the central trajectory was chosen for implantation in 50% of the cases and for the globus pallidus internus (GPi) in 57% of the cases. Furthermore, in 64% of the cases, the channel selected for the permanent electrode corresponded with the trajectory having the longest segment of STN MER activity. For the GPi, this was the case in 61%. The mean and standard deviation of the deepest contact point with respect to the magnetic resonance imaging (MRI)-based target for the STN was 2.1 ± 1.5 mm and for the GPi was -0.5 ± 1.2 mm.

Conclusions: MER facilitates the selection of the final electrode location in STN-DBS and GPi-DBS, and based on the observed MER activity, a pre-selection could be made as to which channel would be the best candidate for macro-test stimulation and at which depth should be stimulated. The choice of the final location is based on intraoperative test stimulation, and it is demonstrated that regularly it is not the central channel that is chosen for implantation. On average, the target as defined by MER activity intensity was in accordance with the MRI-based targets both for the STN and GPi. However, the position of the best MER activity did not necessarily correlate with the locus that produced the most beneficial clinical response on macroelectrode testing intraoperatively.

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Single/multi-unit activity of GPi for various depths (−7.5 to 0 mm). Note that the negative values correspond with positions above the MRI-based target. At −4.5 and −4 mm clearly, the lamina between the external and internal segment of the GP can be observed. The bottom of the GPi is reached at 0 mm
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Fig2: Single/multi-unit activity of GPi for various depths (−7.5 to 0 mm). Note that the negative values correspond with positions above the MRI-based target. At −4.5 and −4 mm clearly, the lamina between the external and internal segment of the GP can be observed. The bottom of the GPi is reached at 0 mm

Mentions: The GPe could be delineated from the dorsally located putamen by an increase in multi-unit firing activity at a depth varying from −12 to −9 mm from the MRI-based target. At advancing depth between −7 to −5 mm, the medial medullary lamina separating the GPe from the GPi was reached. The presence of this lamina was characterized by a decrease in electrical activity and had a thickness of 1 to 2 mm. In the vicinity of the medial medullary lamina, border cells were often recorded with a tonic regular discharge frequency between 5 to 30 Hz. The GPi was usually more densely packed with neurons reflected by a more intense multi-unit activity than observed in the GPe. Also, bursting and pausing activity (dystonia) and tremor-related (in PD) activity were frequently observed in the GPi. Within the GPi, regularly, another lamina at about −2 mm could be observed. The bottom of the GPi was recognized by a sudden decrease in background noise and multi-unit activity as the optic tract was approached (Fig. 2). Data segments were analyzed off-line for stability by visual inspection. When instability or movement/vibration or electrical artifacts were observed, the longest stable section was selected from the recording, discarding the rest.Fig. 2


Long-term experience with intraoperative microrecording during DBS neurosurgery in STN and GPi.

Bour LJ, Contarino MF, Foncke EM, de Bie RM, van den Munckhof P, Speelman JD, Schuurman PR - Acta Neurochir (Wien) (2010)

Single/multi-unit activity of GPi for various depths (−7.5 to 0 mm). Note that the negative values correspond with positions above the MRI-based target. At −4.5 and −4 mm clearly, the lamina between the external and internal segment of the GP can be observed. The bottom of the GPi is reached at 0 mm
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2991152&req=5

Fig2: Single/multi-unit activity of GPi for various depths (−7.5 to 0 mm). Note that the negative values correspond with positions above the MRI-based target. At −4.5 and −4 mm clearly, the lamina between the external and internal segment of the GP can be observed. The bottom of the GPi is reached at 0 mm
Mentions: The GPe could be delineated from the dorsally located putamen by an increase in multi-unit firing activity at a depth varying from −12 to −9 mm from the MRI-based target. At advancing depth between −7 to −5 mm, the medial medullary lamina separating the GPe from the GPi was reached. The presence of this lamina was characterized by a decrease in electrical activity and had a thickness of 1 to 2 mm. In the vicinity of the medial medullary lamina, border cells were often recorded with a tonic regular discharge frequency between 5 to 30 Hz. The GPi was usually more densely packed with neurons reflected by a more intense multi-unit activity than observed in the GPe. Also, bursting and pausing activity (dystonia) and tremor-related (in PD) activity were frequently observed in the GPi. Within the GPi, regularly, another lamina at about −2 mm could be observed. The bottom of the GPi was recognized by a sudden decrease in background noise and multi-unit activity as the optic tract was approached (Fig. 2). Data segments were analyzed off-line for stability by visual inspection. When instability or movement/vibration or electrical artifacts were observed, the longest stable section was selected from the recording, discarding the rest.Fig. 2

Bottom Line: The mean and standard deviation of the deepest contact point with respect to the magnetic resonance imaging (MRI)-based target for the STN was 2.1 ± 1.5 mm and for the GPi was -0.5 ± 1.2 mm.On average, the target as defined by MER activity intensity was in accordance with the MRI-based targets both for the STN and GPi.However, the position of the best MER activity did not necessarily correlate with the locus that produced the most beneficial clinical response on macroelectrode testing intraoperatively.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology/Clinical Neurophysiology, University of Amsterdam, The Netherlands. bour@amc.nl

ABSTRACT

Background: Intraoperative microelectrode recording (MER) for targeting during deep brain stimulation (DBS) procedures has been evaluated over a period of 4 years, in 57 consecutive patients with Parkinson's disease, who received DBS in the subthalamic nucleus (STN-DBS), and 28 consecutive patients with either dystonia (23) or Parkinson's disease (five), in whom the internal segment of the globus pallidus (GPi-DBS) was targeted.

Methods: The procedure for DBS was a one-stage bilateral stereotactic approach using a combined electrode for both MER and macrostimulation. Up to five micro/macro-electrodes were used in an array with a central, lateral, medial, anterior, and posterior position. Final target location was based on intraoperative test stimulation.

Findings: For the STN, the central trajectory was chosen for implantation in 50% of the cases and for the globus pallidus internus (GPi) in 57% of the cases. Furthermore, in 64% of the cases, the channel selected for the permanent electrode corresponded with the trajectory having the longest segment of STN MER activity. For the GPi, this was the case in 61%. The mean and standard deviation of the deepest contact point with respect to the magnetic resonance imaging (MRI)-based target for the STN was 2.1 ± 1.5 mm and for the GPi was -0.5 ± 1.2 mm.

Conclusions: MER facilitates the selection of the final electrode location in STN-DBS and GPi-DBS, and based on the observed MER activity, a pre-selection could be made as to which channel would be the best candidate for macro-test stimulation and at which depth should be stimulated. The choice of the final location is based on intraoperative test stimulation, and it is demonstrated that regularly it is not the central channel that is chosen for implantation. On average, the target as defined by MER activity intensity was in accordance with the MRI-based targets both for the STN and GPi. However, the position of the best MER activity did not necessarily correlate with the locus that produced the most beneficial clinical response on macroelectrode testing intraoperatively.

Show MeSH
Related in: MedlinePlus