Minim Invas Neurosur
-
Minim Invas Neurosur · Dec 2004
Case ReportsSubthalamic nucleus stimulation for advanced Parkinson's disease: how to find a far medial STN.
In a patient with advanced Parkinson's disease, an anatomically deviant far medial subthalamic nucleus (STN) posed problems in the placement of DBS electrodes for chronic high frequency (HF) stimulation despite the use of multimodal targeting with 1) statistical atlas data, 2) T (2)-weighted (T (2)W) magnetic resonance imaging (MRI), 3) microelectrode recording, and 4) clinical testing with macro stimulation. Diagnostic T (2)W MRI suggested that the patient's STN was in a typical location and seemed to confirm the statistical atlas-based planning. Intraoperatively, cell activity recording (MER) with five parallel electrodes could not reveal any STN typical activity profile and electrical stimulation was not able to disclose a medial or lateral displacement of the electrodes. ⋯ Postoperative T (2)W MRI now disclosed a left STN which was 2 mm medial of the initial target and lead to a further medial target definition and finally to a successful DBS placement. In conclusion, finding a deep seated DBS target like the STN can be difficult in cases with an extremely deviant anatomy even if reiterative sophisticated multimodal planning is used. In the presented case we applied the integrated information from intraoperative MER, macrostimulation and postoperative imaging work-up and were able to complete DBS implantation successfully.
-
Minim Invas Neurosur · Dec 2004
Surgical anatomy and efficient modification of procedures for selective extradural anterior clinoidectomy.
The surgical anatomy of structures surrounding the anterior clinoid process (ACP) was examined in 39 cadavers to enable safe performance of selective extradural anterior clinoidectomy. ⋯ We propose a modified, efficient procedure for selective extradural anterior clinoidectomy, as follows. Drilling is started from the point approximately 9 mm posterior to the lateral margin of the dural insertion into the SOP, and pointed medially in the direction with a right angle to the lateral margin of the ACP. After drilling about 6 mm to reach the lateral border of the OC, unroofing of the OC is carried out to remove the ACP en bloc by fracturing of the optic strut. Using the present procedure, the distance of drilling of the lesser wing of the sphenoid bone is minimized.