| Minimizing brain shift in stereotactic functional neurosurgery. | |
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MedLine Citation:
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PMID: 20679927 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Stereotactic functional neurosurgical interventions depend on precise anatomic targeting before lesioning or deep brain stimulation (DBS) electrode placement. OBJECTIVE: To examine the degree of subcortical brain shift observed when adopting an image-guided approach to stereotactic functional neurosurgery. METHODS: Coordinates for the anterior and posterior commissural points (AC and PC) were recorded on thin-slice stereotactic magnetic resonance imaging (MRI) scans performed before and immediately after DBS electrode implantation in 136 procedures. The changes in length of AC-PC and in stereotactic coordinates for AC and PC were calculated for each intervention. In patients with Parkinson disease undergoing bilateral subthalamic nucleus (STN) DBS with at least 6 months of follow-up, pre- and postoperative scores of the motor part of the Unified Parkinson's Disease Rating Scale (UPDRS-III) were reviewed. RESULTS: Mean (SD) change in AC-PC length (DeltaAC-PC) was 0.6 (0.4) mm. There was no statistically significant difference in DeltaAC-PC between groups when examining anatomic target subgroups (P =.95), age subgroups (P = .63), sex (P = .59), and unilateral versus bilateral implantation (P =.15). The mean (SD) vector changes for the commissural points were: -0.1 (0.3) mm in X, -0.4 (0.6) mm in Y, and -0.1 (0.7) mm in Z for the AC; and -0.1 (0.3) mm in X, -0.2 (0.7) mm in Y, and 0.0 (0.7) mm in Z for the PC. There was a negligible correlation between the magnitude of brain shift and percentage improvement in UPDRS-III off-medication in patients undergoing STN DBS for PD (R <0.01). CONCLUSION: Brain shift has long been considered an issue in stereotactic targeting during DBS procedures. However, with the image-guided approach and surgical technique used in this study, subcortical brain shift was extremely limited and did not appear to adversely affect clinical outcome. |
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Authors:
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Erika A Petersen; Etienne M Holl; Irene Martinez-Torres; Thomas Foltynie; Patricia Limousin; Marwan I Hariz; Ludvic Zrinzo |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Neurosurgery Volume: 67 ISSN: 1524-4040 ISO Abbreviation: Neurosurgery Publication Date: 2010 Sep |
Date Detail:
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Created Date: 2010-08-23 Completed Date: 2010-12-13 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 7802914 Medline TA: Neurosurgery Country: United States |
Other Details:
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Languages: eng Pagination: ons213-21; discussion ons221 Citation Subset: IM |
Affiliation:
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Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, Queen Square, London, UK. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Analysis of Variance Anesthesia / methods Deep Brain Stimulation / methods* Electrodes, Implanted Female Humans Magnetic Resonance Imaging / methods Male Middle Aged Neurosurgical Procedures / methods Parkinson Disease / physiopathology, surgery, therapy* Pneumocephalus / etiology Retrospective Studies Stereotaxic Techniques* Subthalamic Nucleus / physiology* Treatment Outcome Young Adult |
| Grant Support | |
ID/Acronym/Agency:
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//Department of Health |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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