Article
Use of multiple trajectories in deep brain stimulation (DBS) of the nucleus ventralis intermedius (VIM)
Search Medline for
Authors
-
Larissa Penner
- Universitätsklinikum Schleswig-Holstein, Campus Kiel, Klinik für Neurochirurgie, Kiel, Deutschland
-
Ann-Kristin Helmers
- Universitätsklinikum Schleswig-Holstein, Campus Kiel, Klinik für Neurochirurgie, Kiel, Deutschland
-
Isabel Lübbing
- Universitätsklinikum Schleswig-Holstein, Campus Kiel, Klinik für Neurochirurgie, Kiel, Deutschland
-
Steffen Paschen
- Universitätsklinikum Schleswig-Holstein, Campus Kiel, Neurologie, Kiel, Deutschland
-
Michael Synowitz
- Universitätsklinikum Schleswig-Holstein, Campus Kiel, Klinik für Neurochirurgie, Kiel, Deutschland
-
H. Maximilian Mehdorn
- Privat-Praxis im Gesundheitszentrum Kiel-Mitte, Neurochirurgie, Kiel, Deutschland
-
Daniela Falk
- Universitätsklinikum Schleswig-Holstein, Campus Kiel, Klinik für Neurochirurgie, Kiel, Deutschland
| Published: | June 18, 2018 |
|---|
Outline
Text
Objective: DBS of the VIM region is a standard procedure for the treatment of medical refractory tremor. In difference to other target points a direct visualization of the VIM in standard MRI’s is not possible. Therefore the intraoperative testing of symptoms is essential. Outcome data for essential tremor in larger series exist, for other indications only case reports or small series were published. Indications, intraoperative methods and the optimal target are under discussion.
Methods: We retrospectively analysed data of all patients, who have undergone DBS-surgery with targeting the VIM, in our department from 2008 until 2016. We recorded age, gender, indications for surgery, number of microelectrodes, trajectory for the permanent electrode, intraoperative reduction of symptoms, reasons for avoiding the central trajectory, the coordinates of the active contacts of the permanent electrode and compared these data with the clinical outcome. Surgeries were all performed under local anaesthesia with MRI-planning and intraoperative microrecording and testing of symptoms.
Results: In the 9 years period 89 DBS-surgeries targeting the VIM were performed, indications for surgery were Essential Tremor 68.5%, MS-Tremor 15.7%, PD-Tremor 4.5%, Orthostatic Tremor 3.4%, Holmes Tremor 2.2%, and other Tremor minorities 5.6%. Mean age of the patients was 61 years ± 14.7 years (range 15 years to 81years), 42.7% were male and 57.3% were female. Bilateral stimulation was performed in 83 patients (93.2%), unilateral in 6 patients.
Within the 172 implantations of VIM-electrodes we were able to use 3 or more microelectrodes for a threedimensional view for microrecording and intraoperative testing in 76.2%, 2 in 14.5%, 1 in 4.1% and without using microelectrodes in 5.2%, regarding individual risk evaluation. For the permanent electrode the central trajectory was chosen in 60.5% 39.5% were implanted over periphery trajectories. Reasons were a better effect less side effects or sometimes a combination of both with sometimes just slight differences.
A good reduction of the symptoms was mainly shown intraoperatively (in a range from 20% effect up to 100% tremor reduction) and was compared to the symptoms reduction under permanent stimulation.
Conclusion: In our patient group we were able to show that intraoperative testing of the tremor symptoms was an essential addition to the pre-operative MRI-based target planning to choose the optimal trajectory for best symptom reduction.
