Intraoperative electrophysiological monitoring determines the final electrode position for pallidal stimulation in dystonia patients
BackgroundBilateral deep brain stimulation (DBS) of the globus pallidus internus (GPi) is an effective treatment for refractory dystonia. Neuroradiological target and stimulation electrode trajectory planning with intraoperative microelectrode recordings (MER) and stimulation are used. With improvin...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2023-05-01
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| Series: | Frontiers in Surgery |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fsurg.2023.1206721/full |
| _version_ | 1797822574827143168 |
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| author | Marek Baláž Jiří Búřil Tereza Jurková Eva Koriťáková Dušan Hrabovský Jonáš Kunst Petra Bártová Jan Chrastina |
| author_facet | Marek Baláž Jiří Búřil Tereza Jurková Eva Koriťáková Dušan Hrabovský Jonáš Kunst Petra Bártová Jan Chrastina |
| author_sort | Marek Baláž |
| collection | DOAJ |
| description | BackgroundBilateral deep brain stimulation (DBS) of the globus pallidus internus (GPi) is an effective treatment for refractory dystonia. Neuroradiological target and stimulation electrode trajectory planning with intraoperative microelectrode recordings (MER) and stimulation are used. With improving neuroradiological techniques, the need for MER is in dispute mainly because of the suspected risk of hemorrhage and the impact on clinical post DBS outcome.ObjectiveThe aim of the study is to compare the preplanned GPi electrode trajectories with final trajectories selected for electrode implantation after electrophysiological monitoring and to discuss the factors potentially responsible for differences between preplanned and final trajectories. Finally, the potential association between the final trajectory selected for electrode implantation and clinical outcome will be analyzed.MethodsForty patients underwent bilateral GPi DBS (right-sided implants first) for refractory dystonia. The relationship between preplanned and final trajectories (MicroDrive system) was correlated with patient (gender, age, dystonia type and duration) and surgery characteristics (anesthesia type, postoperative pneumocephalus) and clinical outcome measured using CGI (Clinical Global Impression parameter). The correlation between the preplanned and final trajectories together with CGI was compared between patients 1–20 and 21–40 for the learning curve effect.ResultsThe trajectory selected for definitive electrode implantation matched the preplanned trajectory in 72.5% and 70% on the right and left side respectively; 55% had bilateral definitive electrodes implanted along the preplanned trajectories. Statistical analysis did not confirm any of the studied factors as predictor of the difference between the preplanned and final trajectories. Also no association between CGI and final trajectory selected for electrode implantation in the right/left hemisphere has been proven. The percentages of final electrodes implanted along the preplanned trajectory (the correlation between anatomical planning and intraoperative electrophysiology results) did not differ between patients 1–20 and 21–40. Similarly, there were no statistically significant differences in CGI (clinical outcome) between patients 1–20 and 21–40.ConclusionThe final trajectory selected after electrophysiological study differed from the preplanned trajectory in a significant percentage of patients. No predictor of this difference was identified. The anatomo-electrophysiological difference was not predictive of the clinical outcome (as measured using CGI parameter). |
| first_indexed | 2024-03-13T10:10:05Z |
| format | Article |
| id | doaj.art-fb1ce8cef2e440b8b4fd2361803a46b3 |
| institution | Directory Open Access Journal |
| issn | 2296-875X |
| language | English |
| last_indexed | 2024-03-13T10:10:05Z |
| publishDate | 2023-05-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Surgery |
| spelling | doaj.art-fb1ce8cef2e440b8b4fd2361803a46b32023-05-22T04:47:31ZengFrontiers Media S.A.Frontiers in Surgery2296-875X2023-05-011010.3389/fsurg.2023.12067211206721Intraoperative electrophysiological monitoring determines the final electrode position for pallidal stimulation in dystonia patientsMarek Baláž0Jiří Búřil1Tereza Jurková2Eva Koriťáková3Dušan Hrabovský4Jonáš Kunst5Petra Bártová6Jan Chrastina7First Department of Neurology, St. Anne’s University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, CzechiaFirst Department of Neurology, St. Anne’s University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, CzechiaInstitute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, CzechiaInstitute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, CzechiaDepartment of Neurosurgery, St. Anne’s University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, CzechiaFirst Department of Neurology, St. Anne’s University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, CzechiaDepartment of Neurology, Faculty Hospital Ostrava, Ostrava, CzechiaDepartment of Neurosurgery, St. Anne’s University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, CzechiaBackgroundBilateral deep brain stimulation (DBS) of the globus pallidus internus (GPi) is an effective treatment for refractory dystonia. Neuroradiological target and stimulation electrode trajectory planning with intraoperative microelectrode recordings (MER) and stimulation are used. With improving neuroradiological techniques, the need for MER is in dispute mainly because of the suspected risk of hemorrhage and the impact on clinical post DBS outcome.ObjectiveThe aim of the study is to compare the preplanned GPi electrode trajectories with final trajectories selected for electrode implantation after electrophysiological monitoring and to discuss the factors potentially responsible for differences between preplanned and final trajectories. Finally, the potential association between the final trajectory selected for electrode implantation and clinical outcome will be analyzed.MethodsForty patients underwent bilateral GPi DBS (right-sided implants first) for refractory dystonia. The relationship between preplanned and final trajectories (MicroDrive system) was correlated with patient (gender, age, dystonia type and duration) and surgery characteristics (anesthesia type, postoperative pneumocephalus) and clinical outcome measured using CGI (Clinical Global Impression parameter). The correlation between the preplanned and final trajectories together with CGI was compared between patients 1–20 and 21–40 for the learning curve effect.ResultsThe trajectory selected for definitive electrode implantation matched the preplanned trajectory in 72.5% and 70% on the right and left side respectively; 55% had bilateral definitive electrodes implanted along the preplanned trajectories. Statistical analysis did not confirm any of the studied factors as predictor of the difference between the preplanned and final trajectories. Also no association between CGI and final trajectory selected for electrode implantation in the right/left hemisphere has been proven. The percentages of final electrodes implanted along the preplanned trajectory (the correlation between anatomical planning and intraoperative electrophysiology results) did not differ between patients 1–20 and 21–40. Similarly, there were no statistically significant differences in CGI (clinical outcome) between patients 1–20 and 21–40.ConclusionThe final trajectory selected after electrophysiological study differed from the preplanned trajectory in a significant percentage of patients. No predictor of this difference was identified. The anatomo-electrophysiological difference was not predictive of the clinical outcome (as measured using CGI parameter).https://www.frontiersin.org/articles/10.3389/fsurg.2023.1206721/fulldeep brain stimulationdystoniaglobus pallidus internusmicrorecordingsstereotaxy |
| spellingShingle | Marek Baláž Jiří Búřil Tereza Jurková Eva Koriťáková Dušan Hrabovský Jonáš Kunst Petra Bártová Jan Chrastina Intraoperative electrophysiological monitoring determines the final electrode position for pallidal stimulation in dystonia patients Frontiers in Surgery deep brain stimulation dystonia globus pallidus internus microrecordings stereotaxy |
| title | Intraoperative electrophysiological monitoring determines the final electrode position for pallidal stimulation in dystonia patients |
| title_full | Intraoperative electrophysiological monitoring determines the final electrode position for pallidal stimulation in dystonia patients |
| title_fullStr | Intraoperative electrophysiological monitoring determines the final electrode position for pallidal stimulation in dystonia patients |
| title_full_unstemmed | Intraoperative electrophysiological monitoring determines the final electrode position for pallidal stimulation in dystonia patients |
| title_short | Intraoperative electrophysiological monitoring determines the final electrode position for pallidal stimulation in dystonia patients |
| title_sort | intraoperative electrophysiological monitoring determines the final electrode position for pallidal stimulation in dystonia patients |
| topic | deep brain stimulation dystonia globus pallidus internus microrecordings stereotaxy |
| url | https://www.frontiersin.org/articles/10.3389/fsurg.2023.1206721/full |
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