Microelectrode-guided pallidotomy: technical approach and its application in medically intractable Parkinson's disease
Microelectrode-guided pallidotomy: technical approach and its application in medically intractable Parkinson's disease
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DOI：
10.3171/jns.1998.88.6.1027
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发表时间：
1998-06-01
影响因子：
4.1
通讯作者：
DeLong, MR
中科院分区：
文献类型：
--
作者：
Vitek, JL;Bakay, RAE;DeLong, MR
物体。作者描述了微电极记录和刺激技术用于苍白球内侧球(GPI)的尾部感觉运动部及其附近结构(内囊和视束)的定位。根据基底节神经元的生理特征以及内囊和视束的微兴奋特性，通过绘制上述结构的地形图来实现定位。尾侧GPI的位置可以通过在立体定向图谱的相关平面上的生理图的“形状拟合”来确定。可以通过评估神经元对被动操作或肢体和口面部结构的主动运动的反应来开发感觉运动图。内囊和视束分别可以通过刺激诱发的运动的存在或患者报告的与刺激同时发生的闪光或斑点来识别。视束也可以通过识别对闪光的神经反应来定位。解剖/生理学图用于指导病变在苍白球感觉运动部分内的放置，同时保留附近的结构，例如苍白球外球、基底核、视束和内囊。1例患者在组织学研究中证实了利用生理记录结合薄层高分辨率磁共振成像对病变进行重建所预测的病变位置和大小。这些数据为特发性帕金森病和其他运动障碍的消融或深部脑刺激手术的靶点识别提供了重要的信息。
Object. The authors describe the microelectrode recording and stimulation techniques used for localizing the caudal sensorimotor portion of the globus pallidus internus (GPI) and nearby structures (internal capsule and optic tract) in patients undergoing GPI pallidotomy.Methods. Localization is achieved by developing a topographic map of the abovementioned structures based on the physiological characteristics of neurons in the basal ganglia and the microexcitable properties of the internal capsule and optic tract. The location of the caudal GPi can be determined by "form fitting" the physiological map on relevant planes of a stereotactic atlas. A sensorimotor map can be developed by assessing neuronal responses to passive manipulation or active movement of the limbs and orofacial structures. The internal capsule and optic tract, respectively, can be identified by the presence of stimulation-evoked movement or the patient's report of flashes or speckles of light that occur coincident with stimulation. The optic tract may also be located by identifying the neural response to flashes of light. The anatomical/physiological map is used to guide lesion placement within the sensorimotor portion of the pallidum while sparing nearby structures, for example, the external globus pallidus, nucleus basalis, optic tract, and internal capsule. The lesion location and size predicted by using physiological recording together with thin-slice high-resolution magnetic resonance imaging reconstructions of the lesion were confirmed in one patient on histological studies.Conclusions. These data provide important information concerning target identification for ablative or deep brain stimulation procedures in idiopathic Parkinson's disease and other movement disorders.