Bockova, M* Dotaz Zobrazit nápovědu
OBJECTIVE: The aim of the paper was to describe the relationship of the anatomical and electrophysiological target for the subthalamic electrode implantation in Parkinson's disease patients defined as the best electrophysiological recordings from multiple paralel electrodes tracts with a target discrepancy explanation. BACKGROUND: Although microrecording is the standard in subthalamic stimulation, microelectrode monitoring prolongs surgical time and may increase the risk of haemorrhagic complications. The main purpose for the electrophysiological mapping is to overcome the discrepancy between the anatomical and electrophysiological targets. METHODS: Subthalamic electrodes were stereotactically implanted in 58 patients using microrecording by means of parallel electrodes at defined distances. The relationship of the final electrode to the anatomical trajectory, the subthalamic nucleus electrical activity length, and the relationship of right and left electrodes were analysed. RESULTS: The final electrode placement matched the anatomical trajectory in 53.4 % of patients on the right side, and 43.1 % of patients on the left side. The electrode position was symmetrical in 38.3 % of patients. The analysis of left and right electrode positions did not prove brain shift as the sole factor responsible for anatomy-functional discrepancy. Further, neither age, Parkinson's disease duration, or L-DOPA adverse effects were confirmed as responsible factors. CONCLUSIONS: The difference between the anatomical trajectory and the final electrode placement underlined the need for functional microelectrode monitoring. Brain shift is not the only causative factor for the difference (Tab. 7, Ref. 27).
- MeSH
- design vybavení MeSH
- dospělí MeSH
- hluboká mozková stimulace přístrojové vybavení MeSH
- lidé středního věku MeSH
- lidé MeSH
- monitorování fyziologických funkcí MeSH
- Parkinsonova nemoc terapie MeSH
- senioři MeSH
- thalamus MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- MeSH
- dětské jesle MeSH
- dítě v ústavní péči MeSH
- kojenec MeSH
- péče o dítě MeSH
- předškolní dítě MeSH
- rodina MeSH
- výchova dítěte MeSH
- vývoj dítěte MeSH
- Check Tag
- kojenec MeSH
- předškolní dítě MeSH
- Publikační typ
- srovnávací studie MeSH
AIM: Advances in neuroradiological planning techniques in deep brain stimulation have put the need for intraoperative electrophysiological monitoring into doubt. Moreover intraoperative monitoring prolongs surgical time and there is potential association between the use of microelectrodes and increased incidence of hemorrhagic complications. The aim of this study was to analyze the correlation between the anatomically planned trajectory and the final subthalamic electrode placement after electrophysiological monitoring in patients with Parkinson"s disease and its change with the increasing experience of the surgical team. MATERIAL AND METHODS: The trajectories of right (first implanted) and left electrodes were compared in the first 50 patients operated on (Group 1) and the next 50 patients (Group 2). RESULTS: In Group 1, 52% of central trajectories were on the right and 38% on the left; in Group 2, the percentage of central trajectories was 76% on the right and 78% on the left; the difference was statistically significant (p=0.021 and 0.001). The difference in the percentage of posterior trajectories reflecting brain shift between the right and left sides was statistically insignificant in Groups 1 (26% and 28%, p=0.999) and 2 (18% and 12%, p=0.549). The percentage of bilateral central electrodes was 14% and 62% in Groups 1 and 2, respectively. CONCLUSION: The correlation between anatomically planned trajectory and final electrode placement markedly improves with the number of patients. However the significant percentage of patients with final electrode trajectory differing from anatomically planned target supports the use of intraoperative monitoring.
- MeSH
- hluboká mozková stimulace metody MeSH
- implantované elektrody MeSH
- intraoperační neurofyziologická monitorace * MeSH
- klinické kompetence MeSH
- křivka učení * MeSH
- lidé středního věku MeSH
- lidé MeSH
- mikroelektrody MeSH
- nucleus subthalamicus fyziologie MeSH
- Parkinsonova nemoc chirurgie MeSH
- senioři MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
