gms | German Medical Science

58. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

26. bis 29.04.2007, Leipzig

Deep brain stimulation of the internal globus pallidus in dystonia: a technique for target localization under general anaesthesia

Tiefe Hirnstimulation des Globus pallidus internus: Operationstechnik, Ergebnisse und Komplikationen

Meeting Abstract

  • corresponding author M.O. Pinsker - Klinik für Neurochirurgie, Universitätsklinikum Schleswig-Holstein, Campus Kiel
  • D. Falk - Klinik für Neurochirurgie, Universitätsklinikum Schleswig-Holstein, Campus Kiel
  • J. Herzog - Klinik für Neurologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel
  • F. Steigerwald - Klinik für Neurologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel
  • J. Volkmann - Klinik für Neurologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel
  • H. M. Mehdorn - Klinik für Neurochirurgie, Universitätsklinikum Schleswig-Holstein, Campus Kiel

Deutsche Gesellschaft für Neurochirurgie. 58. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC). Leipzig, 26.-29.04.2007. Düsseldorf: German Medical Science GMS Publishing House; 2007. DocSO.06.02

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/dgnc2007/07dgnc247.shtml

Published: April 11, 2007

© 2007 Pinsker et al.
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Outline

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Objective: Deep brain stimulation (DBS) of the globus pallidus internus (Gpi) has been shown to be effective in patients with general or segmental dystonia. The authors describe their technical approach for placing electrodes into the Gpi in patients under general anaesthesia, including the methology of electrophysiological mapping of the Gpi, intraoperative test stimulation to determine thresholds for stimulation-induced adverse effects, clinical outcome and complications.

Methods: Forty-two consecutively operated patients (male-to-female 25:17; mean age 43.6 years, range 9 to 74 years) were studied. Two patients had to be reoperated due to infection related electrode explantation in the meantime. One patient had a right-sided pallidotomy 30 years before and was symptomatic on the left side only, so we implanted unilateral. Overall, 86 DBS electrodes were implanted. In 97% of the Gpi stimulations, at least 3 test electrodes were inserted for microelectrode recordings (MER). Permanent electrode was placed according to the results of MER and threshold for contralateral muscle contraction.

Results: The electrodes were implanted as follows: central trajectory in 64%, medial trajectory in 20%, anterior in 9%, lateral and dorsal trajectories in 3.5% each. The analysis after 6 and 12 months revealed substantial improvement in all movement symptoms (with exception of speech and swallowing), the level of disability and quality of life. Postoperative MRI showed asymptomatic infarctions of the corpus caudatus in two patients and asymptomatic small hemorrhages in the lateral basal ganglia in another two patients.

Conclusions: The described technique using stereotactic MRI for direct visualization of the target, intraoperative MER for delineating the boundaries of the target and identification of surrounding structures such as optic tract and macrostimulation for determination of the threshold for adverse events is effective in DBS electrode implantation in patients with dystonia operated under general anaesthesia. The central trajectory was chosen in 64% only, despite adaption of the target due to direct visualization in MRI in 43% of the cases, showing the necessity of combining anatomic with neurophysiological informations.