Skip to main content
SpringerLink
Log in

Electrophysiologic target localization in posteroventral pallidotomy

  • Clinical Articles
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Summary

The current interest in stereotactic posteroventral pallidotomy (PVP) for treating Parkinson's disease and the variability of published results have raised questions regarding techniques for target localization. In our technique the probe is guided to the optimum target at the most ventral pallidum and ansa lenticularis by macroelectrode stimulation of the internal capsule and optic tract from within the globus pallidus, with the thresholds providing a relative measure of the electrode proximity to these structures. We have characterized these localizing macroelectrode stimulation parameters in 57 posteroventral pallidotomies with consistent anatomic lesion placement, excellent outcome, and no complications.

Using a 1.8 × 2.0 mm radiofrequency electrode for macroelectrode stimulation (RFG-3C, Radionics Inc.), minimum voltages (thresholds) to activate motor (at a frequency of 2 Hz) or visual (at a frequency of 100 Hz) responses as well as impedance measurements were obtained at the final target (Tf) and at distances proximal to Tf along the electrode trajectory. The visual and motor threshold voltages at Tf via our standard approach angles (50 ° above base plane, 20 ° from the sagittal plane), had a range of 1.0 to 1.5 V, and 2.0 to 3.5 V respectively. We also found that as the probe approaches Tf there is a significant decrease in voltage thresholds for motor (P<.0001) and visual (P<.0001) responses in an individual patient indicating that the probe is converging on these structures. Increases in impedance between Tf, 2–3 mm, and 4–5 mm proximal to Tf were also statistically significant (P<.0001). Microelectrode recording of electrophysiological neuronal activity at various points along the trajectory towards the target showed distinct firing patters providing identification of the globus pallidus externus and internus, ansa lenticularis, and optic tract.

Macroelectrode electrophysiological stimulation within the target volume, inducing threshold responses in the internal capsule and optic tract, provides for accurate localization of the most effective PVP target in the ansa lenticularis. In unresponsive patients, the utilization of microelectrode recording for the identification of the pallidal borders and the optic tract improves safety.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Baron MS, Vitek JL, Bakay RAE, Green J, Kaneoke Y, Hashimoto T, Turner RS, Woodard JL, Cole SA, McDonald W, Delong MR (1996) Treatment of advanced Parkinson's disease by posterior GPi pallidotomy: 1-Year Results of a Pilot Study. Ann Neurol 40: 355–366

    PubMed  Google Scholar 

  2. Bullard DE, Makachinas TT (1987) Measurement of tissue impedence in conjunction with computed tomography-guided stereotaxic biopsies. J Neurol Neurosurg Psychiatry 50: 43–51

    PubMed  Google Scholar 

  3. Conover WJ (1980) Practical Nonparametric Statistics. Wiley, New York

    Google Scholar 

  4. DeSalles AAF, Brekhus SD, De Souza EC, Behnke EJ, Farahani K, Anzai Y, Lufkin R (1995) Early postoperative appearance of radiofrequency lesions on magnetic resonance imaging. Neurosurgery 36: 932–937

    PubMed  Google Scholar 

  5. Dogali M, Fazzini E, Kolodny E, Eidelberg D, Sterio D, Devinsky O, Beric A (1995) Stereotactic ventral pallidotomy for Parkinson's disease. Neurology 45: 753–761

    PubMed  Google Scholar 

  6. Hariz MI, Bergenheim AT (1990) A comparative study on ventriculographic and computerized tomography-guided determinations of brain targets in functional stereotaxis. J Neurosurg 73: 565–571

    PubMed  Google Scholar 

  7. Iacono RP, Lonser RR, Mandybur G, Morenski JD, Yamada S, Shima F (1994) Stereotactic pallidotomy results for Parkinson's exceed those of fetal graft. Am Surg 60: 777–782

    PubMed  Google Scholar 

  8. Iacono RP, Lonser RR, Mandybur G, Yamada S (1994) Stimulation of the globus pallidus in Parkinson's disease. Br J Neurosurg 9: 505–510

    Google Scholar 

  9. Iacono RP, Nashold BSJ (1991) Stereotactic neurosurgery. In: Sabaston DC (eds) Textbook of surgery: the biological basis of modern surgical practice. Saunders, Washington, pp 1287–1290

    Google Scholar 

  10. Iacono RP, Shima F, Lonser RR, Kuniyoshi S, Maeda G, Yamada S (1995) The results, indications, and physiology of posteroventral pallidotomy for patients with Parkinson's disease. Neuosurgery 36: 1118–1125; discussion 1125–1127

    Google Scholar 

  11. Iacono RP, Yamada S (1995) Posteroventral pallidotomy for patients with Parkinson's disease. In: Renchery E (eds) Color atlas of neurosurgery, American Association of Neurosurgeons, pp 143–153

  12. Kelly PJ (1995) Pallidotomy in Parkinson's disease (editioral; comment). Neurosurgery 36: 1154–1157

    PubMed  Google Scholar 

  13. Kelly PJ, Derome P, Guiot G (1978) Thalamic spatial variability and the surgical results of lesions placed with neurophysiological control. Surg Neurol 9: 307–315

    PubMed  Google Scholar 

  14. Laitinen LV (1995) Pallidotomy for Parkinson's disease. Neurosurg Clin N Am 6: 105–112

    PubMed  Google Scholar 

  15. Laitinen LV (1995) Pallidotomy for Parkinson's disease. Neurosurg Clin N Am 6: 105–112

    PubMed  Google Scholar 

  16. Laitinen LV, Bergenheim AT, Hariz MI (1992) Leksell's posterior ventral pallidotomy in the treatment of Parkinson's disease. J Neurosurg 76: 53–61

    Google Scholar 

  17. Laitinen LV, Bergenheim AT, Hariz MI (1992) Ventroposterolateral pallidotomy can abolish all pakinsonian symptoms. Stereotact Funct Neurosurg 58: 14–21

    PubMed  Google Scholar 

  18. Lozano A, Hutchison W, Kiss Z, Tasker R, Davis K, Dostrovsky J (1996) Methods for microelectrode-guided posteroventral pallidotomy. J Neurosurg 84: 194–202

    PubMed  Google Scholar 

  19. Mandybur G, Morenski J, Kuniyoshi S, Iacono RP (1995) Comparison of MRI and ventriculographic target acquisition for posteroventral pallidotomy. Stereotact Funct Neurosurg 65: 54–59

    PubMed  Google Scholar 

  20. Marsden CD (1990) Parkinson's disease. Lancet 948–952

  21. Moringlane JR, Koch R, Schafer H, Ostertag CB (1989) Experimental radiofrequency (RF) coagulation with computer-based on line monitoring of temperature and power. Acta Neurochir (Wien) 96: 126–131

    Google Scholar 

  22. Narabayashi H (1990) Surgical treatment in the levodopa era. In: Stern G (eds) Parkinson's disease. Chapman and Hall, London, pp 597–646

    Google Scholar 

  23. Papanastassiou V, Rowe J, Aziz T (In Press) Use of the radionics image fusion and stereoplan programme for target localisation in functional neurosurgery. Image Guided Surgery

  24. Shad L, Lott S, Schmitt F, Sturm V, Loranz W (1987) Correction of spatial distortion in MR imaging: A prerequisit for accurate stereotaxy. J Comput Assist Tomography 11: 499–505

    Google Scholar 

  25. Shima F, Kato M, Fukui M, Iacono RP (1992) Posteroventral pallidotomy in treatment of Parkinson's disease. Funct Neurosurg 31: 51–58

    Google Scholar 

  26. Sterio D, Berio A, Dogali M, Fazzini E, Alfaro G, Devinsky O (1994) Neurophysiological properties of pallidal neurons in Parkinson's disease. Ann Neurol 35: 586–591

    PubMed  Google Scholar 

  27. Sumanaweera TS, Adler JR, Napel S, Glover GH (1994) Characterization of spatial distortion in magnetic resonance imaging and its implications for stereotactic surgery. Neurosurgery 35: 696–704

    PubMed  Google Scholar 

  28. Svennilson E, Torvik ARL, Leskell L (1960) Treatment of Parkinsonism by stereotactic thermolesions in pallidal region. Psychiatr Neurol Scand 35: 358–377

    Google Scholar 

  29. Villemure JG, Marchand TP, Peters T, Leroux G, Olivier A (1987) Magnetic resonance imaging stereotaxy: Recognition and utilization of the commisures. Appl Neurophysiol 50: 57–62

    PubMed  Google Scholar 

  30. Vincas FC, Zamorano L, Dujovny M, Zhao JZ, Hodgkinson D, Ho KL, Ausman JI (1992) In vivo and in vitro study of the lesions produced with a computerized radiofrequency system. Stereotact Funct Neurosurg 58: 121–133

    PubMed  Google Scholar 

Download references

Author information

Author notes

  1. R. P. Iacono M. D., F.A.C.S.

    Present address: , 11234 Anderson Street, Room 2539, 92354, Loma Linda, CA, USA

Authors and Affiliations

  1. Movement Disorders and Clinical Neuroscience, Loma Linda University Medical Center, CA, USA

    R. P. Iacono M. D., F.A.C.S., J. D. Carlson, S. M. Kuniyoshi, Y. J. Li, A. S. Mohamed & G. Maeda

Authors
  1. R. P. Iacono M. D., F.A.C.S.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J. D. Carlson
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S. M. Kuniyoshi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Y. J. Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. A. S. Mohamed
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. G. Maeda
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Iacono, R.P., Carlson, J.D., Kuniyoshi, S.M. et al. Electrophysiologic target localization in posteroventral pallidotomy. Acta neurochir 139, 433–441 (1997). https://doi.org/10.1007/BF01808880

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01808880

Keywords

Search

Navigation