Microelectrode Recording during Posteroventral Pallidotomy: Impact on Target Selection and Complications
- 1 February 1999
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Neurosurgery
- Vol. 44 (2), 315-321
- https://doi.org/10.1097/00006123-199902000-00036
Abstract
To assess the practical usefulness of single-cell microelectrode recording (MER) when performing posteroventral pallidotomy. A retrospective comparison of the initial, magnetic resonance imaging-derived coordinates of the pallidotomy target to the final, MER-refined lesion coordinates in 132 consecutive pallidotomies was conducted. The time required to perform the procedure and the surgical complications are reported. MER led to targeting changes in 98% of the cases. In 12%, the MER-refined target was more than 4 mm from the original, image-guided site, which is a targeting error that could adversely affect outcome. Although all components of targeting were affected by MER, laterality and depth were impacted most. The ventral border of the globus pallidus pars interna was located within 1 mm of the magnetic resonance imaging-selected target in only 40% of the cases. On average, only 2.2 MER trajectories were required to perform pallidotomy. During the last 3 years of our study, 85% of the procedures were performed with one or two trajectories. The mean operating time of the operations performed during the last 3 years was 2 hours and 12 minutes. The incidence of intracerebral hemorrhage in our series (1.5%) was no higher than that reported for other large series of stereotactic procedures. No patient suffered an optic tract injury. MER provides important targeting information for performing pallidotomy. In particular, the micrometric delineation of the ventral border of the globus pallidus pars interna permits safe lesioning of the posteroventral region of the globus pallidus pars interna with little risk of visual field deficit. These data can be obtained efficiently and without increased surgical risk.Keywords
This publication has 23 references indexed in Scilit:
- Treatment of advanced Parkinson's disease by posterior GPi pallidotomy: 1‐year results of a pilot studyAnnals of Neurology, 1996
- Electrical Stimulation of the Globus pallidus Preceding Stereotactic Posteroventral PallidotomyStereotactic and Functional Neurosurgery, 1996
- Stereotactic ventral pallidotomy for Parkinson's diseaseNeurology, 1995
- Complications of CT-guided stereotactic biopsy of intra-axial brain lesionsJournal of Neurosurgery, 1994
- Differential neuronal activity in segments of globus pallidus in Parkinsonʼs disease patientsNeuroReport, 1994
- Anatomic and Physiological Considerations in Pallidotomy for Parkinson's DiseaseStereotactic and Functional Neurosurgery, 1994
- Magnetic Resonance Imaging and Anatomic Atlas Mapping for ThalamotomyStereotactic and Functional Neurosurgery, 1992
- Computed Imaging Stereotaxy: Experience and Perspective Related to 500 Procedures Applied to Brain MassesNeurosurgery, 1987
- Primate globus pallidus and subthalamic nucleus: functional organizationJournal of Neurophysiology, 1985
- Activity of pallidal neurons during movement.Journal of Neurophysiology, 1971