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Related Experiment Videos

Stereotactic ventrolateral thalamotomy: is ventriculography necessary?

R L Alterman1, B A Kall, H Cohen

  • 1Department of Neurological Surgery, New York University Medical Center, New York, USA.

Neurosurgery
|October 1, 1995
PubMed
Summary

Ventriculography may not be necessary for accurate ventrolateral thalamotomy. A multimodality correlative imaging technique (MCIT) significantly improved CT/MRI accuracy, reducing lesion distance and enabling safe procedures without ventriculography.

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Area of Science:

  • Neurosurgery
  • Medical Imaging
  • Stereotactic Procedures

Background:

  • Ventriculography has been traditionally used for accurate ventrolateral thalamotomy.
  • The advent of computed tomography/magnetic resonance imaging (CT/MRI) has raised questions about the necessity of ventriculography.

Purpose of the Study:

  • To retrospectively compare CT/MRI-derived coordinates with ventriculography/microelectrode-determined lesion coordinates for ventrolateral thalamotomy.
  • To evaluate the impact of a multimodality correlative imaging technique (MCIT) on the accuracy of CT/MRI-based thalamotomy targeting.

Main Methods:

  • Retrospective analysis of 74 thalamotomies performed between 1984 and 1994.
  • Comparison of pre-operative CT/MRI coordinates with post-operative ventriculography and microelectrode recording data.

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  • Evaluation of thalamotomies performed with and without the MCIT, implemented since 1990.

    • Main Results:

    • The median 3D distance between CT/MRI and ventriculography/microelectrode loci was 4.7 mm.
    • The multimodality correlative imaging technique (MCIT) significantly improved the correlation between CT/MRI and ventriculography/microelectrode coordinates.
    • MCIT reduced the median absolute difference along the Y-axis from 4.0 to 1.8 mm (P=0.0001) and the median 3D distance from 5.6 to 3.7 mm (P=0.0007).

    Conclusions:

    • Ventrolateral thalamotomies can be performed safely and effectively without ventriculography.
    • The multimodality correlative imaging technique (MCIT), combined with neurophysiological monitoring, enhances the accuracy of CT/MRI-guided thalamotomies.