Artikel
Results of a series of 55 consecutive patients with movement disorders treated by bilateral micro-electrode-guided stereotactic STN, GPI and VIM – DBS with a time - saving intraoperative protocol of reduced teststimulation: looking mainly for stimulation–induced side effects
Resultate einer Serie von 55 Patienten mit Bewegungsstörungen und bilateraler stereotaktischer Elektrodenimplantation in STN, GPI und VIM - operiert mit Hilfe der Mikroableitung und einem zeitsparenden intraoperativen Teststimulationsprotokoll
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Autoren
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F. Hertel
- Department of Neurosurgery, Brüderkrankenhaus, Trier
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M. Züchner
- Department of Neurosurgery, Brüderkrankenhaus, Trier
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C. Decker
- Department of Neurosurgery, Brüderkrankenhaus, Trier
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I. Weimar
- Department of Neurology, Brüderkrankenhaus, Trier
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B. Rohrscheider
- Department of Neurology, Brüderkrankenhaus, Trier
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M. Bettag
- Department of Neurosurgery, Brüderkrankenhaus, Trier
| Veröffentlicht: | 4. Mai 2005 |
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Gliederung
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Objective
To describe the results of STN - DBS operations planned with CT - MRI matching under microelectrode guidance with a time saving intraoperative teststimulation protocol.
Background
Despite the increasing number of papers reporting about the usefulness of microrecording (MER) in DBS procedures, the widespread standard is still an excessive intraoperative test stimulation. Though there is a proved efficacy of this classical type of operation, intraoperative MER bears additional information about the 3D extension of the STN. Time consuming intraoperative testing may be burdening for the patients. Additionally after the insertion of the test electrode there may be an immediate significant improvement of the symptoms and therefore the effect of stimulation on the parkinsonian symptoms may be difficult to determine.
Methods
A consecutive series of 55 patients underwent stereotactic DBS procedures because of advanced parkinson's disease, essential tremor, DYT-1 negative Dystonia and Holmes tremor between 2001 and 2004. The procedures were planned by CT - MRI image - fusion and 3-dimensional trajectory planning. All patients had an intraoperative microrecording with a simultaneous recording of 1 to 5 (mean 3) microelectrode trajectories. Furthermore, all patients had an intraoperative teststimulation, looking mainly for side effects at rapidly increasing stimulation intensities. All patients were scored by UPDRS pre- and every three months postoperatively. A postoperative CT was performed in all cases and matched with the intraoperative planning datasets.
Results
The mean operation time for a bilateral procedure was 3,5 hours. The mean improvement in the UPDRS III was 70% with a mean reduction of dopaminergic treatment of 60%. We had 2 intracerebral bleedings (ICH)(one leading to a haematoma evacuation), both without any residual symptoms due to the ICH. One system infection lead to a temporary explantation of the system. One system had to be removed because of an unsatisfactory effect of the DBS.
Conclusions
The combination of intraoperative MER (with 1 to 5 simultaneous trajectories) with a reduced protocol of teststimulation is a safe, time saving and effective procedure with reduced burden for the patient.
