Abordaje seguro al núcleo subtalámico. Impacto del ángulo parasagital mayor de 20 grados.

Nelson Ernesto Quintanal Cordero; Rafael Rodríguez Rojas; Maylen Carballo Barreda; Iván García Maeso; Juan Teijeiro Amador; Raúl Macías González; Karla Batista García-Ramó; Ivón Pedroso Ibáñez

doi:10.47924/neurotarget201962

Authors

Nelson Ernesto Quintanal Cordero Centro Internacional de Restauración Neurológica. (CIREN). La Habana. Cuba. https://orcid.org/0000-0003-3812-5899
Rafael Rodríguez Rojas Centro Internacional de Restauración Neurológica. (CIREN). La Habana. Cuba.
Maylen Carballo Barreda Centro Internacional de Restauración Neurológica. (CIREN). La Habana. Cuba.
Iván García Maeso Centro Internacional de Restauración Neurológica. (CIREN). La Habana. Cuba.
Juan Teijeiro Amador Centro Internacional de Restauración Neurológica. (CIREN). La Habana. Cuba.
Raúl Macías González Centro Internacional de Restauración Neurológica. (CIREN). La Habana. Cuba.
Karla Batista García-Ramó Centro Internacional de Restauración Neurológica. (CIREN). La Habana. Cuba.
Ivón Pedroso Ibáñez Centro Internacional de Restauración Neurológica. (CIREN). La Habana. Cuba.

DOI:

https://doi.org/10.47924/neurotarget201962

Keywords:

Ablative surgery, Parkinson disease, subthalamic nucleus, subthalamotomy

Abstract

Objective: To evaluate the precision, effectiveness and safety in the identification and lesion of subthalamic nucleus using a new surgical strategy, guided by images and multi-unit deep brain electrical recording. Special attention was given to ventricular dilation and cerebral atrophy in relation to electrode trajectory and the accuracy of the surgical target’s location.

Method: A prospective study for the identification and lesion of subthalamic nucleus in 49 surgeries performed at the same number of patients with Parkinsons disease. The method for locating the surgical target was based on images of stereotactic computed tomography, multi-unit deep brain electrical recording with semimicroelectrode and electrical micro-stimulation. The recommended parasagittal trajectory was modified for this type of procedure that is between 0 and 15 degrees, at a value equal to or greater than 20 degrees in the first recording trajectory, with the aim of avoiding the lateral ventricle, blood vessels and brain grooves. The trajectories of the electrodes were analyzed in the postoperative magnetic resonance imaging of the skull. Statistical methods were used to assess the effectiveness of the procedure for the location and lesion of the surgical target.

Results: The electrical activity of the subthalamic nucleus was identified in the first trajectory of multi-unit brain recording in 83.7% of the procedures. The average number of trajectories per procedure was 5 and the paths necessary for subthalamic nucleus lesion were 2. The mean parasagittal angle on the first path was 21.72 degrees, with a minimum of 20 degrees and a maximum of 27.5.

Conclusions: The method of anatomical and electrophysiological location used, following a parasagittal angle equal to or greater than 20 degrees, is effective and surgically safe to identify the subthalamic nucleus and perform its lesion in patients with Parkinson disease, thus avoiding the ventricular system, blood vessels and brain grooves.

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