Tratamiento quirúrgico de la Enfermedad de Parkinson. Importancia de la distancia intercomisural en la planificación quirúrgica

Raisa C. Braña Miranda; Nelson E. Quintanal Cordero; Nancy Pavón Fuentes; Ivón Pedroso Ibáñez; Raúl Macías González; Juan Teijeiro Amador; Armando Abreu Duque; Randis Garbey Fernández

doi:10.47924/neurotarget2023461

Authors

Raisa C. Braña Miranda International Center for Neurological Restoration (CIREN), Havana, Cuba https://orcid.org/0000-0003-0608-7728
Nelson E. Quintanal Cordero CENIT Foundation for Neuroscience Research, Autonomous City of Buenos Aires, Argentina https://orcid.org/0000-0003-3812-5899
Nancy Pavón Fuentes International Center for Neurological Restoration (CIREN), Havana, Cuba https://orcid.org/0000-0003-0998-8601
Ivón Pedroso Ibáñez International Center for Neurological Restoration (CIREN), Havana, Cuba https://orcid.org/0000-0001-6983-9398
Raúl Macías González International Center for Neurological Restoration (CIREN), Havana, Cuba https://orcid.org/0000-0002-5920-4521
Juan Teijeiro Amador International Center for Neurological Restoration (CIREN), Havana, Cuba https://orcid.org/0009-0001-5743-1843
Armando Abreu Duque International Center for Neurological Restoration (CIREN), Havana, Cuba https://orcid.org/0000-0001-9159-8009
Randis Garbey Fernández International Center for Neurological Restoration (CIREN), Havana, Cuba https://orcid.org/0000-0003-2803-7596

DOI:

https://doi.org/10.47924/neurotarget2023461

Keywords:

Parkinson's disease, subthalamic nucleus, internal globus pallidus nucleus, intercommissural distance, stereotactic coordinates

Abstract

Introduction: The meticulous use of neuroimaging to plan the position of the surgical target and the trajectory towards it can avoid risk factors related to surgery, so optimizing the anatomical identification of the internal globus pallidus nucleus (GPi) and the subthalamic nucleus (STN) would allow for fewer deep brain recordings, reduce surgical time, as well as the risk of complications associated with surgery.
Methods: A retrospective, descriptive-correlational study with a longitudinal design was carried out in the Neurosurgery service of CIREN. The study universe consisted of 19 patients diagnosed with Parkinson's disease who underwent surgery of both cerebral hemispheres at different surgical times, with the GPi being the first nucleus to be addressed and then the STN. The initial coordinates of the surgical target, the coordinates of the lesions and their relationship with the intercommissural distance are described.
Results: Despite the approach to both nuclei (GPi and NST) was performed at different surgical moments and the average time between both surgeries was 4.5 years, no significant difference was found in the intercommissural distance at both surgical moments in the same patient. The intercommissural distance found in men was greater than that found in women. Although there was variation between the initial coordinates (approximation coordinates) and the lesion coordinates, this difference was not statistically significant for any of the coordinate axes in both surgeries. The intercommissural distance (distance between the anterior commissure and the posterior commissure) significantly influenced the lateral and anteroposterior location of the lesion coordinates selected in both nuclei. Conclusions: This study suggests that for planning the initial and lesion coordinates for these surgeries, the intercommissural distance should be taken into account, since it correlates positively with the mediolateral and anteroposterior distance in which the GPi and NST nuclei are located. In addition, it is important to consider the patient's gender, since in males the intercommissural distance is significantly greater than in females.

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References

Hariz M. Stereotactic ablative surgery does not just mean «adding another lesion». Mov Disord. julio de 2017;32(7):1112-3.

Sharma VD, Patel M, Miocinovic S. Surgical Treatment of Parkinson’s Disease: Devices and Lesion Approaches. Neurother J Am Soc Exp Neurother. 2020;17(4):1525-38.

Duker AP, Espay AJ. Surgical treatment of Parkinson disease: past, present, and future. Neurol Clin. 2013;31(3):799-808.

Rodriguez-Oroz MC, Obeso JA, Lang AE, Houeto JL, Pollak P, Rehncrona S, et al. Bilateral deep brain stimulation in Parkinson’s disease: a multicentre study with 4 years follow-up. Brain. 2005;128(10):2240-9.

Okun Michael S. Deep-Brain Stimulation for Parkinson’s Disease. N Engl J Med. 367(16):1529-38.

Lee PS, Crammond DJ, Richardson RM. Deep Brain Stimulation of the Subthalamic Nucleus and Globus Pallidus for Parkinson’s Disease. Prog Neurol Surg. 2018;33:207-21.

Peng L, Fu J, Ming Y, Zeng S, He H, Chen L. The long-term efficacy of STN vs GPi deep brain stimulation for Parkinson disease: A meta-analysis. Medicine. 2018;97 (35).

Tesio V, Rizzi L, Jiang T, Fronda C, Lanotte M, Castelli L. Deep brain stimulation of the subthalamic nucleus in Parkinson’s disease: Relationship between the electrode trajectory and cognitive decline. Parkinsonism Relat Disord. 2019;61:45-9.

Pedroso Ibáñez I, Álvarez González L, Macías R, López Flores G, Rodríguez-Rojas R, Teijeiro Amador J, et al. Cirugía lesional como alternativa de tratamiento quirúrgico en la enfermedad de Parkinson. Experiencia del CIREN a largo plazo. Rev Mex Neuroci. 2006;7(6): 562-72.

Lopez-Flores G, Miguel-Morales J, Teijeiro-Amador J, Vitek J, Perez-Parra S, Fernandez-Melo R, et al. Anatomic and neurophysiological methods for the targeting and lesioning of the subthalamic nucleus: Cuban experience and review. Neurosurgery. 2003;52(4):817-30; discussion 831.

Lang AE. Surgery for Parkinson disease: A critical evaluation of the state of the art. Arch Neurol. 2000;57(8):1118-25.

Quintanal Cordero NE, Rodriguez Rojas R, Carballo Barreda M, García Maeso I, Teijeiro Amador J, Macias González R, et al. Abordaje seguro al núcleo subtalámico. Impacto del ángulo parasagital mayor de 20 grados. NeuroTarget. 2019;13(4).

A J Hughes, S E Daniel, L Kilford, A J Lees. Accuracy of clinical diagnosis of idiopathic Parkinson’s disease: a clinico-pathological study of 100 cases. J Neurol Neurosurg Amp Psychiatry. 1992;55(3):181.

Torres Montoya A, Pereira J. Testing the precision of stereotactic planning systems. Comput Med Imaging Graph Off J Comput Med Imaging Soc. 1998;22(4):317-21.

Carballo M, Rodríguez R, López G, Torres A. Sistema tridimensional de planeamiento quirúrgico para PC. Ing Electrónica Automática Comun. 2005;26:19-23.

Teijeiro J, Macias RJ, Maragoto C, Garcia I, Alvarez M, Quintanal NE. [Deep brain recording and length of surgery in stereotactic and functional neurosurgery for movement disorders]. Neurocir Astur. 2014;25(3):116-27.

Teijeiro Amador J, Macías González RJ. Sistema computarizado de registro cerebral profundo como guía neuroquirúrgica en trastorno del movimiento. Rev Mex Neuroci. 2005;6(5):393-8.

Lang AE, Duff J, Saint-Cyr JA, Trepanier L, Gross RE, Lombardi W, et al. Posteroventral medial pallidotomy in Parkinson’s disease. J Neurol. 1999;246 Suppl 2:II28-41.

Jourdain VA, Schechtmann G, Di Paolo T. Subthalamotomy in the treatment of Parkinson’s disease: clinical aspects and mechanisms of action. J Neurosurg. 2014;120(1):140-51.

Alvarez González L, Macías González R, López Flores G, Alvarez González E, Maragoto Rizo C, García Maeso I, et al. Palidotomía posteroventral selectiva guiada por semimicroregistro en el tratamiento de los estadios avanzados de la enfermedad de Parkinson idiopática. Rev Mex Neuroci. 2001;2(2):87-96.

Blomstedt P, Hariz GM, Hariz MI. Pallidotomy versus pallidal stimulation. Parkinsonism Relat Disord. 2006;12(5):296-301.

Garcia-Garcia D, Guridi J, Toledo JB, Alegre M, Obeso JA, Rodríguez-Oroz MC. Stimulation sites in the subthalamic nucleus and clinical improvement in Parkinson’s disease: a new approach for active contact localization. J Neurosurg. 2016;125(5):1068-79.

Balestrino R, Schapira AHV. Parkinson disease. Eur J Neurol. 2020;27(1):27-42.

Guridi J, Rodriguez-Rojas R, Carmona-Abellán M, Parras O, Becerra V, Lanciego JL. History and future challenges of the subthalamic nucleus as surgical target: Review article. Mov Disord. 2018;33(10):1540-50.

Tyurnikov VM, Nizametdinova DM, Gushcha AO, Fedotova EY, Poleshchuk VV, Timerbaeva SL, et al. [Unilateral posteroventral pallidotomy in the treatment of drug-induced dyskinesia in Parkinson’s disease]. Zh Vopr Neirokhir Im N N Burdenko. 2017;81(5):69-75.

Alvarez L, Macias R, Guridi J, Lopez G, Alvarez E, Maragoto C, et al. Dorsal subthalamotomy for Parkinson’s disease. Mov Disord. 2001;16(1):72-8.

Merello M, Tenca E, Pérez Lloret S, Martín ME, Bruno V, Cavanagh S, et al. Prospective randomized 1-year follow-up comparison of bilateral subthalamotomy versus bilateral subthalamic stimulation and the combination of both in Parkinson’s disease patients: a pilot study. Br J Neurosurg. 2008;22(3):415-22.

Adamec D, Leiguarda F, Driollet Laspiur S, Bartoli G, Ziliani J, Travi JP, et al. Subtalamotomía bilateral diferida en enfermedad de Parkinson: evaluación motora, cognitiva y conductual. Neurol Argent. 2015;7(2):67-75.

Guridi J, Rodríguez-Oroz MC, Manrique M. Tratamiento quirúrgico de la enfermedad de Parkinson. Neurocirugía. 2004;15(1):5-16.

DeLong MR. Primate models of movement disorders of basal ganglia origin. Trends Neurosci. 1990;13(7):281-5.

Laitinen LV, Bergenheim AT, Hariz MI. Leksell’s posteroventral pallidotomy in the treatment of Parkinson’s disease. J Neurosurg. 1992;76(1):53-61.