Microdiálisis cerebral, una herramienta promisoria para el estudio neuroquímico en neurocirugía: Una descripción técnica

Sergio A. Sacchettoni; Pedro Rada; Luis Teneud; Ramón Galué; Juan Poincaré Abud; Juan Félix Del Corral

doi:10.47924/neurotarget2010305

Authors

Sergio A. Sacchettoni Neurosurgery Service, José María Vargas Hospital. Caracas. Venezuela.
Pedro Rada Behavioral Physiology Laboratory, Faculty of Medicine, University of Los Andes, Mérida, Venezuela
Luis Teneud Behavioral Physiology Laboratory, Faculty of Medicine, University of Los Andes, Mérida, Venezuela
Ramón Galué Neurology Service, Vicente Salias Military Hospital, Fuerte Tiuna, Caracas
Juan Poincaré Abud Antigen Study Laboratory, Institute of Biomedicine, Ministry of Health, Venezuela
Juan Félix Del Corral Neurosurgery Service, José María Vargas Hospital. Caracas. Venezuela.

DOI:

https://doi.org/10.47924/neurotarget2010305

Keywords:

surgery of Parkinson’s disease; , cerebral microdialysis, deep brain stimulation (DBS), subthalamic nucleus, globus pallidum intarnae, thalamus

Abstract

Introduction: In Venezuela, since 1997 we are using the technique of cerebral microdialysis (CMD) during stereotactic surgery for Parkinson’s disease (PD) and obsessive compulsive disorder (OCD) to study the neurochemistry of neuronal circuits involved in the pathophysiology of these diseases, by monitoring the concentrations of excitatory and inhibitory neurotransmitters and their variations in response to the application of high frequency electrical impulses and to radiofrequency ablation or DBS procedures.

Materials and methods: In order to study PD, we used the multiple and dynamic CMD technique during thalamotomy, pallidotomy and implantation of DBS electrodes in the subthalamic nucleus (STN). Samples were collected using CMD probes placed in the globus pallidum internae (GPi) and / or ventrolateral nucleus (VL) of the thalamus at various times: before, during and after application of high frequency electrical impulses (inhibitory, 100-120 Hz and 2-4 V) in the surgical “target” (STN, GPi, or VL), and finally, after radiofrequency ablation (thalamotomy or pallidotomy) or after placement of the electrodes of neuromodulation. The CMD is performed with the patient awake, without sedation. For the study of OCD, we took samples from the dorsomedian thalamus, on the right side or bilaterally, before, during and after ablation (cingulotomy) on each side.

Results: In patients with PD, the concentration of extracellular GABA in the VL decreased during the application of high frequency electrical impulses in the GPi and returned to its initial value after the electrical inhibition was suspended, and decreased permanently after destruction of the GPi (pallidotomy) or reversibly with the DBS of the GPi. The level of glutamate (Glu) decreased when the electrical impulses were applied on the STN (“indirect pathway” of the basal ganglia). In addition, when we applied electrical impulses in the STN, there was an increase in the concentration of GABA in the GPi, which should normally be released by the axons from the putamen (“direct path”). In patients with OCD, the level of GABA in the dorsomedian nucleus (DM) of the right thalamus decreased discreetly after left cingulotomy (contralateral) and more pronouncedly with right cingulotomy (ipsilateral).

Discussion and conclusions: We observed decreased GABA levels in the VL and Glu in the GPi during application of electrical impulses in the GPi or the STN, respectively, which is expected according to the pathophysiological model of the basal ganglia currently accepted. However, raising the level of GABA in the GPi during the application of electrical impulses in the NST suggests an interaction between direct and indirect pathways, which was unknown until now. And the psychosurgery findings seem to confirm that OCD has its pathophysiological substrate in the basal ganglia, hence, we could propose that OCD has a mechanism similar to the PD. These results, although no statistically significant, encourage us to continue this research.

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