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Published on: June 22, 2017
Microelectrode recording during posteroventral pallidotomy: impact on target selection and complications
R L Alterman1, D Sterio, A Beric
1The Institute for Neurology and Neurosurgery, Beth Israel Medical Center, North Division, New York, New York 10128, USA.
Objective:
To assess the practical usefulness of single-cell microelectrode recording (MER) when performing posteroventral pallidotomy.
Methods:
A retrospective comparison of the initial, magnetic resonance imaging-derived coordinates of the pallidotomy target to the final, MER-refined lesion coordinates in 132 consecutive pallidotomies was conducted. The time required to perform the procedure and the surgical complications are reported.
Results:
MER led to targeting changes in 98% of the cases. In 12%, the MER-refined target was more than 4 mm from the original, image-guided site, which is a targeting error that could adversely affect outcome. Although all components of targeting were affected by MER, laterality and depth were impacted most. The ventral border of the globus pallidus pars interna was located within 1 mm of the magnetic resonance imaging-selected target in only 40% of the cases. On average, only 2.2 MER trajectories were required to perform pallidotomy. During the last 3 years of our study, 85% of the procedures were performed with one or two trajectories. The mean operating time of the operations performed during the last 3 years was 2 hours and 12 minutes. The incidence of intracerebral hemorrhage in our series (1.5%) was no higher than that reported for other large series of stereotactic procedures. No patient suffered an optic tract injury.
Conclusion:
MER provides important targeting information for performing pallidotomy. In particular, the micrometric delineation of the ventral border of the globus pallidus pars interna permits safe lesioning of the posteroventral region of the globus pallidus pars interna with little risk of visual field deficit. These data can be obtained efficiently and without increased surgical risk.
Insights
Single-cell microelectrode recording (MER) significantly refined targeting for posteroventral pallidotomy in 98% of cases. This technique improves accuracy and safety, especially for lesioning the globus pallidus pars interna, with minimal increased surgical risk.
Area of Science:
- Neurosurgery
- Neurology
- Medical Technology
Background:
- Posteroventral pallidotomy is a neurosurgical procedure.
- Accurate targeting is crucial for effective and safe pallidotomy.
- Image-guided targeting may have limitations in precision.
Purpose of the Study:
- To evaluate the clinical utility of single-cell microelectrode recording (MER) in posteroventral pallidotomy.
- To compare MER-guided targeting with initial magnetic resonance imaging (MRI)-derived coordinates.
Main Methods:
- Retrospective analysis of 132 consecutive posteroventral pallidotomies.
- Comparison of MRI-based target coordinates with MER-refined lesion coordinates.
- Assessment of procedure duration and surgical complications.
Main Results:
- MER resulted in targeting adjustments in 98% of procedures.
- Significant deviations ( > 4 mm) between MRI and MER targets occurred in 12% of cases.
- MER accurately delineated the globus pallidus pars interna, enabling safe lesioning with low risk of visual complications and no increase in hemorrhage rates.
Conclusions:
- Microelectrode recording (MER) is highly valuable for precise targeting in posteroventral pallidotomy.
- MER allows for micrometric definition of the globus pallidus pars interna, enhancing safety and efficacy.
- The procedure is efficient, requiring few trajectories with acceptable operating times and low complication rates.
