Visual evoked potential guidance for posteroventral pallidotomy in Parkinson's disease

Visual evoked potentials (VEPs) to photic stimulation of the eyes were used to identify the optic tract and thus determine the location of the globus pallidus internus (GPi) in eight patients with Parkinson's disease who then underwent posteroventral pallidotomy. Distinct waves appeared at 1 or 2 mm below the target (4 to 5 mm below the intercommissural line) and the amplitude significantly increased at 5 or 6 mm below, strongly suggesting that the electrode was in contact with the optic tract. In the medio-lateral direction, potentials were successively recorded in an area of 4 to 8 mm length, indicating the width of the optic tract. The trajectory at the mid point showed the most significant potentials which suggested the center of the optic tract. The site of the first lesion was placed 0 to 2 mm lateral to this trajectory and 5 mm above the point at which the amplitudes of responses increased. The actual lesion site significantly differed from the tentative target in a medio-lateral direction by 1 to 5 mm (mean 3.0 +/- 1.5 mm, n = 6). The Unified Parkinson's Disease Rating Scale score significantly improved and magnetic resonance imaging taken 2 or 3 weeks after the operation showed a lesion within the GPi in each patient. Recording of VEPs greatly facilitates accurate determination of the GPi.