Variability in lesion location after microelectrode-guided pallidotomy for Parkinson's disease : anatomical, physiological, and technical factors that determine lesion distribution
Identifieur interne : 003790 ( Main/Exploration ); précédent : 003789; suivant : 003791Variability in lesion location after microelectrode-guided pallidotomy for Parkinson's disease : anatomical, physiological, and technical factors that determine lesion distribution
Auteurs : R. E. Gross [Canada] ; W. J. Lombardi ; W. D. Hutchison ; S. Narula ; J. A. Saint-Cyr ; J. O. Dostrovsky ; R. R. Tasker ; A. E. Lang ; A. M. LozanoSource :
- Journal of neurosurgery [ 0022-3085 ] ; 1999.
Descripteurs français
- Pascal (Inist)
- Wicri :
- topic : Homme.
English descriptors
- KwdEn :
- Adult, Advanced stage, Aged, Brain Mapping, Cohort Studies, Distribution, Electric Stimulation, Globus Pallidus (pathology), Globus Pallidus (physiopathology), Globus Pallidus (surgery), Human, Humans, Lesion, Localization, Magnetic Resonance Imaging, Microelectrode, Microelectrodes, Middle Aged, Nuclear magnetic resonance imaging, Pallidum, Parkinson Disease (diagnosis), Parkinson Disease (surgery), Parkinson disease, Postoperative Period, Stereotaxic Techniques (instrumentation), Technique, Thermocoagulation, Time Factors, Treatment, Variability, Volumetric analysis.
- MESH :
- diagnosis : Parkinson Disease.
- instrumentation : Stereotaxic Techniques.
- pathology : Globus Pallidus.
- physiopathology : Globus Pallidus.
- surgery : Globus Pallidus, Parkinson Disease.
- Adult, Aged, Brain Mapping, Cohort Studies, Electric Stimulation, Humans, Magnetic Resonance Imaging, Microelectrodes, Middle Aged, Postoperative Period, Time Factors.
Abstract
Object. To understand the factors that determine the distribution of lesions after microelectrode-guided pallidotomy for Parkinson's disease, the authors quantitatively characterized lesion location in a cohort of patients who were prospectively followed to determine the effects of pallidotomy on clinical outcome. Methods. Thirty-three patients underwent volumetric magnetic resonance (MR) imaging after surgery to allow quantitative lesion localization in relation to conventional intraventricular landmarks and, alternatively, more anatomically relevant landmarks, The validity of the method was verified in a cohort of postpallidotomy patients who underwent concurrent volumetric and stereotactic MR imaging in an external head frame. Lesions were distributed over a considerable distance in the anteroposterior (8.8 mm) and mediolateral (8.7 mm) dimensions in relation to the anterior commissure and wall of the third ventricle, respectively. Less variation was seen in lesion location in the dorsoventral dimension (4.8 mm) in relation to the intercommissural plane. Conclusions. Lesion distribution was not random: lesion locations in the anteroposterior and mediolateral dimensions were highly correlated, such that lesions were distributed from anteromedial to posterolateral, parallel to the border of the globus pallidus internus with the obliquely oriented internal capsule. The factors that led to variability in lesion location were variation in third ventricle width and the oblique anteromedial-to-posterolateral course of the internal capsule. This demonstration of variability of lesion location in a cohort of patients who experienced excellent clinical benefits and minimal postoperative complications emphasizes the importance of anatomical variations in determining lesion position and the need for physiological corroboration for correct lesion placement.
Affiliations:
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E." last="Gross">R. E. Gross</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>Departments of Surgery, Anatomy and Cell Biology, Physiology, and Medicine, University of Toronto</s1><s2>Toronto, Ontario</s2><s3>CAN</s3></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><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>Division of Neurosurgery, Department of Psychology, and Division of Neurology, The Toronto Hospital</s1><s2>Toronto, Ontario</s2><s3>CAN</s3></inist:fA14><country>Canada</country><wicri:noRegion>Toronto, Ontario</wicri:noRegion></affiliation></author><author><name sortKey="Lombardi, W J" sort="Lombardi, W J" uniqKey="Lombardi W" first="W. J." last="Lombardi">W. J. Lombardi</name></author><author><name sortKey="Hutchison, W D" sort="Hutchison, W D" uniqKey="Hutchison W" first="W. D." last="Hutchison">W. D. Hutchison</name></author><author><name sortKey="Narula, S" sort="Narula, S" uniqKey="Narula S" first="S." last="Narula">S. Narula</name></author><author><name sortKey="Saint Cyr, J A" sort="Saint Cyr, J A" uniqKey="Saint Cyr J" first="J. A." last="Saint-Cyr">J. A. Saint-Cyr</name></author><author><name sortKey="Dostrovsky, J O" sort="Dostrovsky, J O" uniqKey="Dostrovsky J" first="J. O." last="Dostrovsky">J. O. Dostrovsky</name></author><author><name sortKey="Tasker, R R" sort="Tasker, R R" uniqKey="Tasker R" first="R. R." last="Tasker">R. R. Tasker</name></author><author><name sortKey="Lang, A E" sort="Lang, A E" uniqKey="Lang A" first="A. E." last="Lang">A. E. Lang</name></author><author><name sortKey="Lozano, A M" sort="Lozano, A M" uniqKey="Lozano A" first="A. M." last="Lozano">A. M. Lozano</name></author></analytic><series><title level="j" type="main">Journal of neurosurgery</title><title level="j" type="abbreviated">J. neurosurg.</title><idno type="ISSN">0022-3085</idno><imprint><date when="1999">1999</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">Journal of neurosurgery</title><title level="j" type="abbreviated">J. neurosurg.</title><idno type="ISSN">0022-3085</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adult</term><term>Advanced stage</term><term>Aged</term><term>Brain Mapping</term><term>Cohort Studies</term><term>Distribution</term><term>Electric Stimulation</term><term>Globus Pallidus (pathology)</term><term>Globus Pallidus (physiopathology)</term><term>Globus Pallidus (surgery)</term><term>Human</term><term>Humans</term><term>Lesion</term><term>Localization</term><term>Magnetic Resonance Imaging</term><term>Microelectrode</term><term>Microelectrodes</term><term>Middle Aged</term><term>Nuclear magnetic resonance imaging</term><term>Pallidum</term><term>Parkinson Disease (diagnosis)</term><term>Parkinson Disease (surgery)</term><term>Parkinson disease</term><term>Postoperative Period</term><term>Stereotaxic Techniques (instrumentation)</term><term>Technique</term><term>Thermocoagulation</term><term>Time Factors</term><term>Treatment</term><term>Variability</term><term>Volumetric analysis</term></keywords><keywords scheme="MESH" qualifier="diagnosis" xml:lang="en"><term>Parkinson Disease</term></keywords><keywords scheme="MESH" qualifier="instrumentation" xml:lang="en"><term>Stereotaxic Techniques</term></keywords><keywords scheme="MESH" qualifier="pathology" xml:lang="en"><term>Globus Pallidus</term></keywords><keywords scheme="MESH" qualifier="physiopathology" xml:lang="en"><term>Globus Pallidus</term></keywords><keywords scheme="MESH" qualifier="surgery" xml:lang="en"><term>Globus Pallidus</term><term>Parkinson Disease</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Adult</term><term>Aged</term><term>Brain Mapping</term><term>Cohort Studies</term><term>Electric Stimulation</term><term>Humans</term><term>Magnetic Resonance Imaging</term><term>Microelectrodes</term><term>Middle Aged</term><term>Postoperative Period</term><term>Time Factors</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Parkinson maladie</term><term>Stade avancé</term><term>Thermocoagulation</term><term>Pallidum</term><term>Microélectrode</term><term>Imagerie RMN</term><term>Volumétrie</term><term>Distribution</term><term>Lésion</term><term>Localisation</term><term>Variabilité</term><term>Traitement</term><term>Technique</term><term>Homme</term><term>Pallidotomie</term></keywords><keywords scheme="Wicri" type="topic" xml:lang="fr"><term>Homme</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Object. To understand the factors that determine the distribution of lesions after microelectrode-guided pallidotomy for Parkinson's disease, the authors quantitatively characterized lesion location in a cohort of patients who were prospectively followed to determine the effects of pallidotomy on clinical outcome. Methods. Thirty-three patients underwent volumetric magnetic resonance (MR) imaging after surgery to allow quantitative lesion localization in relation to conventional intraventricular landmarks and, alternatively, more anatomically relevant landmarks, The validity of the method was verified in a cohort of postpallidotomy patients who underwent concurrent volumetric and stereotactic MR imaging in an external head frame. Lesions were distributed over a considerable distance in the anteroposterior (8.8 mm) and mediolateral (8.7 mm) dimensions in relation to the anterior commissure and wall of the third ventricle, respectively. Less variation was seen in lesion location in the dorsoventral dimension (4.8 mm) in relation to the intercommissural plane. Conclusions. Lesion distribution was not random: lesion locations in the anteroposterior and mediolateral dimensions were highly correlated, such that lesions were distributed from anteromedial to posterolateral, parallel to the border of the globus pallidus internus with the obliquely oriented internal capsule. The factors that led to variability in lesion location were variation in third ventricle width and the oblique anteromedial-to-posterolateral course of the internal capsule. This demonstration of variability of lesion location in a cohort of patients who experienced excellent clinical benefits and minimal postoperative complications emphasizes the importance of anatomical variations in determining lesion position and the need for physiological corroboration for correct lesion placement.</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="Dostrovsky, J O" sort="Dostrovsky, J O" uniqKey="Dostrovsky J" first="J. O." last="Dostrovsky">J. O. Dostrovsky</name><name sortKey="Hutchison, W D" sort="Hutchison, W D" uniqKey="Hutchison W" first="W. D." last="Hutchison">W. D. Hutchison</name><name sortKey="Lang, A E" sort="Lang, A E" uniqKey="Lang A" first="A. E." last="Lang">A. E. Lang</name><name sortKey="Lombardi, W J" sort="Lombardi, W J" uniqKey="Lombardi W" first="W. J." last="Lombardi">W. J. Lombardi</name><name sortKey="Lozano, A M" sort="Lozano, A M" uniqKey="Lozano A" first="A. M." last="Lozano">A. M. Lozano</name><name sortKey="Narula, S" sort="Narula, S" uniqKey="Narula S" first="S." last="Narula">S. Narula</name><name sortKey="Saint Cyr, J A" sort="Saint Cyr, J A" uniqKey="Saint Cyr J" first="J. A." last="Saint-Cyr">J. A. Saint-Cyr</name><name sortKey="Tasker, R R" sort="Tasker, R R" uniqKey="Tasker R" first="R. R." last="Tasker">R. R. Tasker</name></noCountry><country name="Canada"><region name="Ontario"><name sortKey="Gross, R E" sort="Gross, R E" uniqKey="Gross R" first="R. E." last="Gross">R. E. Gross</name></region><name sortKey="Gross, R E" sort="Gross, R E" uniqKey="Gross R" first="R. E." last="Gross">R. E. Gross</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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