COMPARISON OF THREE METHODS OF TARGETING THE SUBTHALAMIC NUCLEUS FOR CHRONIC STIMULATION IN PARKINSON'S DISEASE
Identifieur interne : 002412 ( Main/Exploration ); précédent : 002411; suivant : 002413COMPARISON OF THREE METHODS OF TARGETING THE SUBTHALAMIC NUCLEUS FOR CHRONIC STIMULATION IN PARKINSON'S DISEASE
Auteurs : Yuri M. Andrade-Souza [Canada] ; Jason M. Schwalb [Canada] ; Clement Hamani [Canada] ; Hazem Eltahawy [Canada] ; Tasnuva Hoque [Canada] ; Jean Saint-Cyr [Canada] ; Andres M. Lozano [Canada] ; Roy A. E. Bakay ; Ali R. Rezai ; Philip A. StarrSource :
- Neurosurgery [ 0148-396X ] ; 2008.
Descripteurs français
- Pascal (Inist)
- Wicri :
- topic : Maladie chronique, Chirurgie.
English descriptors
- KwdEn :
Abstract
OBJECTIVE: The success of subthalamic nucleus (STN) surgery for Parkinson's disease depends on accuracy in target determination. The objective of this study was to determine which of the following techniques was most accurate and precise in identifying the location for stimulation in STN deep brain stimulation surgery that is most clinically effective: direct targeting, indirect targeting using the positions of the anterior and posterior commissures, or a technique using the red nucleus (RN) as an internal fiducial marker. METHODS: We reviewed 14 patients with Parkinson's disease treated with bilateral STN deep brain stimulation (28 STN targets). Electrode implantation was based on direct and indirect targeting using two-dimensional magnetic resonance imaging with refinement using microelectrode recording. Optimal settings, including the contacts used, were determined during the clinical follow-up. The position of the best contact was defined with postoperative magnetic resonance imaging. This location was compared with the modified direct, indirect, and RN-based targets. The mean distances between the targets and the final position of the optimal contact were calculated. The accuracy and variance of each target were analyzed. RESULTS: The mean position of the best contact was x = 12.12 (standard deviation [SD], 1.45 mm), y = -2.41 (SD, 1.63 mm), and z = -2.39 (SD, 1.49 mm) relative to the midcommissural point. The mean distance between the optimal contact position and the planned target was 3.19 mm (SD, 1.19 mm) using the RN-based method, 3.42 mm (SD, 1.34 mm) using indirect targeting, and 4.66 mm (SD, 1.33 mm) using a modified direct target. The mean distance between the optimal contact and the RN-based target was significantly smaller than the mean distance between the optimal contact and the direct target (post hoc with Tamhane's correction, P < 0.001) but not between the optimal contact and the indirect target. The RN-based target had the smallest variance (Ftest, P < 0.001), indicating greater precision. CONCLUSION: The use of the RN as an internal fiducial marker for targeting the optimal region of STN stimulation was reliable and closely approximates the position of the electrode contact that provides the optimal clinical results.
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Lozano</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>Division of Neurosurgery, University of Toronto</s1><s2>Toronto, Ontario</s2><s3>CAN</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>7 aut.</sZ></inist:fA14><country>Canada</country><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName><orgName type="university">Université de Toronto</orgName></affiliation></author><author><name sortKey="Bakay, Roy A E" sort="Bakay, Roy A E" uniqKey="Bakay R" first="Roy A. E." last="Bakay">Roy A. E. Bakay</name></author><author><name sortKey="Rezai, Ali R" sort="Rezai, Ali R" uniqKey="Rezai A" first="Ali R." last="Rezai">Ali R. Rezai</name></author><author><name sortKey="Starr, Philip A" sort="Starr, Philip A" uniqKey="Starr P" first="Philip A." last="Starr">Philip A. Starr</name></author></titleStmt><publicationStmt><idno type="wicri:source">INIST</idno><idno type="inist">08-0276372</idno><date when="2008">2008</date><idno type="stanalyst">PASCAL 08-0276372 INIST</idno><idno type="RBID">Pascal:08-0276372</idno><idno type="wicri:Area/PascalFrancis/Corpus">000646</idno><idno type="wicri:Area/PascalFrancis/Curation">000664</idno><idno type="wicri:Area/PascalFrancis/Checkpoint">000563</idno><idno type="wicri:explorRef" wicri:stream="PascalFrancis" wicri:step="Checkpoint">000563</idno><idno type="wicri:doubleKey">0148-396X:2008:Andrade Souza Y:comparison:of:three</idno><idno type="wicri:Area/Main/Merge">002624</idno><idno type="wicri:Area/Main/Curation">002412</idno><idno type="wicri:Area/Main/Exploration">002412</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a">COMPARISON OF THREE METHODS OF TARGETING THE SUBTHALAMIC NUCLEUS FOR CHRONIC STIMULATION IN PARKINSON'S DISEASE</title><author><name sortKey="Andrade Souza, Yuri M" sort="Andrade Souza, Yuri M" uniqKey="Andrade Souza Y" first="Yuri M." last="Andrade-Souza">Yuri M. Andrade-Souza</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>Division of Neurosurgery, University of Toronto</s1><s2>Toronto, Ontario</s2><s3>CAN</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>7 aut.</sZ></inist:fA14><country>Canada</country><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName><orgName type="university">Université de Toronto</orgName></affiliation></author><author><name sortKey="Schwalb, Jason M" sort="Schwalb, Jason M" uniqKey="Schwalb J" first="Jason M." last="Schwalb">Jason M. Schwalb</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>Division of Neurosurgery, University of Toronto</s1><s2>Toronto, Ontario</s2><s3>CAN</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>7 aut.</sZ></inist:fA14><country>Canada</country><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName><orgName type="university">Université de Toronto</orgName></affiliation></author><author><name sortKey="Hamani, Clement" sort="Hamani, Clement" uniqKey="Hamani C" first="Clement" last="Hamani">Clement Hamani</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>Division of Neurosurgery, University of Toronto</s1><s2>Toronto, Ontario</s2><s3>CAN</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>7 aut.</sZ></inist:fA14><country>Canada</country><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName><orgName type="university">Université de Toronto</orgName></affiliation></author><author><name sortKey="Eltahawy, Hazem" sort="Eltahawy, Hazem" uniqKey="Eltahawy H" first="Hazem" last="Eltahawy">Hazem Eltahawy</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>Division of Neurosurgery, University of Toronto</s1><s2>Toronto, Ontario</s2><s3>CAN</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>7 aut.</sZ></inist:fA14><country>Canada</country><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName><orgName type="university">Université de Toronto</orgName></affiliation></author><author><name sortKey="Hoque, Tasnuva" sort="Hoque, Tasnuva" uniqKey="Hoque T" first="Tasnuva" last="Hoque">Tasnuva Hoque</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>Division of Neurosurgery, University of Toronto</s1><s2>Toronto, Ontario</s2><s3>CAN</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>7 aut.</sZ></inist:fA14><country>Canada</country><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName><orgName type="university">Université de Toronto</orgName></affiliation></author><author><name sortKey="Saint Cyr, Jean" sort="Saint Cyr, Jean" uniqKey="Saint Cyr J" first="Jean" last="Saint-Cyr">Jean Saint-Cyr</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>Division of Neurosurgery, University of Toronto</s1><s2>Toronto, Ontario</s2><s3>CAN</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>7 aut.</sZ></inist:fA14><country>Canada</country><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName><orgName type="university">Université de Toronto</orgName></affiliation></author><author><name sortKey="Lozano, Andres M" sort="Lozano, Andres M" uniqKey="Lozano A" first="Andres M." last="Lozano">Andres M. Lozano</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>Division of Neurosurgery, University of Toronto</s1><s2>Toronto, Ontario</s2><s3>CAN</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>7 aut.</sZ></inist:fA14><country>Canada</country><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName><orgName type="university">Université de Toronto</orgName></affiliation></author><author><name sortKey="Bakay, Roy A E" sort="Bakay, Roy A E" uniqKey="Bakay R" first="Roy A. E." last="Bakay">Roy A. E. Bakay</name></author><author><name sortKey="Rezai, Ali R" sort="Rezai, Ali R" uniqKey="Rezai A" first="Ali R." last="Rezai">Ali R. Rezai</name></author><author><name sortKey="Starr, Philip A" sort="Starr, Philip A" uniqKey="Starr P" first="Philip A." last="Starr">Philip A. Starr</name></author></analytic><series><title level="j" type="main">Neurosurgery</title><title level="j" type="abbreviated">Neurosurgery</title><idno type="ISSN">0148-396X</idno><imprint><date when="2008">2008</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">Neurosurgery</title><title level="j" type="abbreviated">Neurosurgery</title><idno type="ISSN">0148-396X</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Chronic disease</term><term>Comparative study</term><term>Encephalon</term><term>Nervous system diseases</term><term>Nuclear magnetic resonance imaging</term><term>Parkinson disease</term><term>Red nucleus</term><term>Stereotaxia</term><term>Subthalamic nucleus</term><term>Surgery</term><term>Targeting</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Maladie chronique</term><term>Maladie de Parkinson</term><term>Pathologie du système nerveux</term><term>Etude comparative</term><term>Ciblage</term><term>Noyau sousthalamique</term><term>Encéphale</term><term>Imagerie RMN</term><term>Noyau rouge</term><term>Stéréotaxie</term><term>Chirurgie</term></keywords><keywords scheme="Wicri" type="topic" xml:lang="fr"><term>Maladie chronique</term><term>Chirurgie</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">OBJECTIVE: The success of subthalamic nucleus (STN) surgery for Parkinson's disease depends on accuracy in target determination. The objective of this study was to determine which of the following techniques was most accurate and precise in identifying the location for stimulation in STN deep brain stimulation surgery that is most clinically effective: direct targeting, indirect targeting using the positions of the anterior and posterior commissures, or a technique using the red nucleus (RN) as an internal fiducial marker. METHODS: We reviewed 14 patients with Parkinson's disease treated with bilateral STN deep brain stimulation (28 STN targets). Electrode implantation was based on direct and indirect targeting using two-dimensional magnetic resonance imaging with refinement using microelectrode recording. Optimal settings, including the contacts used, were determined during the clinical follow-up. The position of the best contact was defined with postoperative magnetic resonance imaging. This location was compared with the modified direct, indirect, and RN-based targets. The mean distances between the targets and the final position of the optimal contact were calculated. The accuracy and variance of each target were analyzed. RESULTS: The mean position of the best contact was x = 12.12 (standard deviation [SD], 1.45 mm), y = -2.41 (SD, 1.63 mm), and z = -2.39 (SD, 1.49 mm) relative to the midcommissural point. The mean distance between the optimal contact position and the planned target was 3.19 mm (SD, 1.19 mm) using the RN-based method, 3.42 mm (SD, 1.34 mm) using indirect targeting, and 4.66 mm (SD, 1.33 mm) using a modified direct target. The mean distance between the optimal contact and the RN-based target was significantly smaller than the mean distance between the optimal contact and the direct target (post hoc with Tamhane's correction, P < 0.001) but not between the optimal contact and the indirect target. The RN-based target had the smallest variance (Ftest, P < 0.001), indicating greater precision. CONCLUSION: The use of the RN as an internal fiducial marker for targeting the optimal region of STN stimulation was reliable and closely approximates the position of the electrode contact that provides the optimal clinical results.</div></front></TEI><affiliations><list><country><li>Canada</li></country><region><li>Ontario</li></region><settlement><li>Toronto</li></settlement><orgName><li>Université de Toronto</li></orgName></list><tree><noCountry><name sortKey="Bakay, Roy A E" sort="Bakay, Roy A E" uniqKey="Bakay R" first="Roy A. E." last="Bakay">Roy A. E. Bakay</name><name sortKey="Rezai, Ali R" sort="Rezai, Ali R" uniqKey="Rezai A" first="Ali R." last="Rezai">Ali R. Rezai</name><name sortKey="Starr, Philip A" sort="Starr, Philip A" uniqKey="Starr P" first="Philip A." last="Starr">Philip A. Starr</name></noCountry><country name="Canada"><region name="Ontario"><name sortKey="Andrade Souza, Yuri M" sort="Andrade Souza, Yuri M" uniqKey="Andrade Souza Y" first="Yuri M." last="Andrade-Souza">Yuri M. Andrade-Souza</name></region><name sortKey="Eltahawy, Hazem" sort="Eltahawy, Hazem" uniqKey="Eltahawy H" first="Hazem" last="Eltahawy">Hazem Eltahawy</name><name sortKey="Hamani, Clement" sort="Hamani, Clement" uniqKey="Hamani C" first="Clement" last="Hamani">Clement Hamani</name><name sortKey="Hoque, Tasnuva" sort="Hoque, Tasnuva" uniqKey="Hoque T" first="Tasnuva" last="Hoque">Tasnuva Hoque</name><name sortKey="Lozano, Andres M" sort="Lozano, Andres M" uniqKey="Lozano A" first="Andres M." last="Lozano">Andres M. Lozano</name><name sortKey="Saint Cyr, Jean" sort="Saint Cyr, Jean" uniqKey="Saint Cyr J" first="Jean" last="Saint-Cyr">Jean Saint-Cyr</name><name sortKey="Schwalb, Jason M" sort="Schwalb, Jason M" uniqKey="Schwalb J" first="Jason M." last="Schwalb">Jason M. 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