gms | German Medical Science

60. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit den Benelux-Ländern und Bulgarien

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

24. - 27.05.2009, Münster

Functional MR-guided motor cortex stimulation technique in central post-stroke pain: analysis of surgical results and technique

Meeting Abstract

  • B. Pirotte - Erasme Hospital, Université Libre de Bruxelles
  • P. Voordecker - Erasme Hospital, Université Libre de Bruxelles
  • X. Detiege - Erasme Hospital, Université Libre de Bruxelles
  • C. Neugroschl - Erasme Hospital, Université Libre de Bruxelles
  • D. Baleriaux - Erasme Hospital, Université Libre de Bruxelles
  • N. Mathieu - Erasme Hospital, Université Libre de Bruxelles

Deutsche Gesellschaft für Neurochirurgie. 60. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit den Benelux-Ländern und Bulgarien. Münster, 24.-27.05.2009. Düsseldorf: German Medical Science GMS Publishing House; 2009. DocMI.03-01

DOI: 10.3205/09dgnc177, URN: urn:nbn:de:0183-09dgnc1776

Veröffentlicht: 20. Mai 2009

© 2009 Pirotte et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective: To present our preliminary results with motor cortex stimulation (MCS) in a series of central pos-stroke pain (CPSP) patients operated by means of a combined intraoperative cortical brain mapping (iCM) and functional MRI-guidance.

Methods: 21 consecutive patients, 11 females and 10 males, aged 33–73 years (mean 55.6 years) suffering from chronic refractory pain syndrome secondary to central ischemic somatosensory lesions underwent surgery for the implantation of an epidural MCS device under general anaesthesia and with a frameless surgery navigation system used for the image-guided targeting procedure. We combined epidural iCM with image-guidance as previously published. In all patients, we identified the motor cortex activation by preoperative BOLD (Blood oxygenation level dependent) fMRI pulse sequences acquired within the same imaging session than the anatomical MRI scanning. We compared intraoperatively fMRI-defined and ICM-defined targets.

Results: Although representing the most direct, faithful and precise functional technique for recording neuronal activity in the primary cortical areas, iCM unfortunately presented some limitations that reduced significantly the quality of the targeting method (approximate target in 3/21; non reproducible target in 6/21 cases). Correspondence between contours of fMRI activation area and iCM in precentral gyrus was found in 20/21 patients (96%). Fifteen of them still showed correspondence for more restrictive values of the AT (p<0.0001). In the other 6, the quality of the iCM was reduced by somatosensory wave attenuation and general anesthesia. In this group, combining both techniques was used for the final targeting. Correspondence was not found in one patient as result of image distortion and residual motion artefacts. Excellent or good pain relief was obtained in 16 patients (76%).

Conclusions: Although reaching a high success rate in CPSP, MCS remains under evaluation because the underlying mechanisms are still largely unknown. The accuracy of the electrode positioning is without doubt a crucial step to obtain pain relief. Combining different functional imaging methods to the iCM might improve the quality of the cortical targeting.