Imaging-intensive guidance with confirmatory physiological mapping for neurosurgery of movement disorders

摘要

Abstract: Stereotactic surgery for movement disorders istypically performed using both imaging and physiologicguidance. However, different neurosurgical centers varyin the emphasis placed on either the imaging or thephysiological mapping used to locate the target in thebrain. The relative ease with which imaging data isacquired currently and the relative complexity andinvasiveness associated with physiologic mappingprompted an evaluation of a method that seeks tomaximize the imaging component of the guidance in orderto minimize the need for the physiologic mapping. Theevaluation was carried out in 37 consecutivestereotactic procedures for movement disorders in 28patients. Imaging was performed with the patients in astereotactic head frame. Imaging data from MRI in threeplanes, CT and positive contrast ventriculography wasall referenced to this headframe and combined in astereotactic planning computer. Physiologic definitionof the target was performed by macroelectrodestimulation. Any discrepancy between the coordinates ofthe imaging predicted target and physiologicallydefined target was measured. The imaging- predictedtarget coordinates allowed the physiologically definedtarget to be reached on the first electrode penetrationin 70 percent of procedures and within two penetrationsin 92 percent. The mean error between imaging predictedand physiologically defined target position was 1.24mm. Lesion location was confirmed by postoperative MRI.There were no permanent complications in this series.Functional outcomes were comparable to those achievedby centers mapping with multiple microelectrodepenetrations. The findings suggest that whilephysiologic guidance remains necessary, the extent towhich it is needed can be reduced by acquiring as muchimaging information as possible in the initial stagesof the procedure. These data can be combined andprioritized in a stereotactic planning computer suchthat the surgeon can take full advantage of the mostreliable information from each imaging modality. !30