Implantación de electrodos para la electromodulación cerebral profunda del núcleo subtalámico en la enfermedad de Parkinson sin microrregistro intraoperatorio

Juan Abud; Penélope Mantilla; Aníbal Piñero; Ramón Galué; Juan Félix Del Corral; Sergio A. Sacchettoni

doi:10.47924/neurotarget2009338

Authors

Juan Abud “Vargas” Hospital, Caracas. Venezuela.
Penélope Mantilla “Vargas” Hospital, Caracas. Venezuela.
Aníbal Piñero “Vargas” Hospital, Caracas. Venezuela.
Galué Ramón “Vargas” Hospital, Caracas. Venezuela.
Juan Félix Del Corral “Vargas” Hospital, Caracas. Venezuela.
Sergio A. Sacchettoni “Vargas” Hospital, Caracas. Venezuela.

DOI:

https://doi.org/10.47924/neurotarget2009338

Keywords:

deep brain stimulation, subthalamic nucleus, intraoperative micro recording, Parkinson’s disease

Abstract

Introduction: The use of cerebral micro recording (MR) during implantation of deep brain stimulation (DBS) electrodes for Parkinson’s disease has become a subject of debate worldwide. The experience of our group in Parkinson’s surgery began in the decade of 1960, it was exposed in the First Latin American Course of this field, and is still in progress. The different surgical techniques comprised from ventrolateral thalamotomy and ventral-postero- lateral pallidotomy to the current mode is the DBS of the subthalamic nucleus (STN). In this paper we describe a series of 16 patients operated on using bilateral subthalamic nucleus stimulation but without intraoperative micro recording.

Surgical technique: Coordinates of the STN are calculated directly on the stereotactic magnetic resonance image (MRI). The mathematical target of the system is verified by intraoperative fluoroscopy. Electrical pulses of high (100 Hz) and low (5 Hz) frequency are applied by means of a test intracerebral electrode (Micromar®, São Paulo, Brasil), with increasing intensity (0,5 to 6,0 volts). A neurologist monitors the improvement of motor symptoms of the awaken patient. Once the desired results are obtained the definitive electrodes are implanted intracerebrally and connected to the pulse generator, which is placed subcutaneously immediately after giving full sedation to the patient. The mean duration of the operative part of the surgery was 4 hours.

Results: Three out of 16 patients were reoperated on for relocation of the electrodes. At a mean of one year of follow up there was a mean of reduction of 41% in the motor Unified Parkinson’s Disease Rating Scale (UPDRS) and a 55% general improvement based on a subjective analogic visual scale.

Conclusion: In the absence of intraoperative micro recording, this surgery can be done with acceptable safety and accuracy. We assume that short surgery (i.e. without the time-consuming by MR) avoids fatigue and increases patient’s tolerance and collaboration.

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