Microelectrode Targeting of the Subthalamic Nucleus for Deep Brain Stimulation Surgery
Identifieur interne : 001061 ( Main/Exploration ); précédent : 001060; suivant : 001062Microelectrode Targeting of the Subthalamic Nucleus for Deep Brain Stimulation Surgery
Auteurs : Erwin B. Jr Montgomery [États-Unis]Source :
- Movement disorders [ 0885-3185 ] ; 2012.
Descripteurs français
- Pascal (Inist)
- Wicri :
- topic : Chirurgie.
English descriptors
- KwdEn :
Abstract
Though microelectrode recordings likely increase the risks and costs of DBS, incremental improvement in accuracy may translate into improved outcomes that justify these risks and costs. Clinically based, controlled studies to resolve these issues are problematic. Until such studies are reported, physicians must rely on indirect evidence. The spatial variability of physiologically defined optimal targets, as determined by microelectrode recording (MER), necessary for targeting the STN was calculated. Study of the effectiveness of a MER algorithm was based on the number of penetrations required. The radius of the volume with a 99% chance of including the physiologically defined optimal target, based on 108 cases, was 4.5 mm. This is larger than the estimated radius of the DBS effect, which is variously estimated to be 2 to 3.9 mm. The 99% confidence radius in the plane orthogonal to the lead was 3.2 mm. In 70% of cases, the imaging-based trajectories corresponded to the physiologically defined optimal target. For the remaining 30% of cases, 70% required only a single additional MER tract. The radii of the 99% confidence volume and area may be larger than the effective radius of stimulation. Surveying within those volumes or areas is therefore necessary to assure that at least 99% of cases will cover the physiologically defined target. The MER algorithm was robust in detecting the physiologically defined optimal target. However, there are significant caveats in interpretation of the data.
Affiliations:
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Le document en format XML
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Jr Montgomery</name><affiliation wicri:level="2"><inist:fA14 i1="01"><s1>Department of Neurology, University of Alabama at Birmingham</s1><s2>Birmingham, Alabama</s2><s3>USA</s3><sZ>1 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Alabama</region></placeName></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">INIST</idno><idno type="inist">12-0393082</idno><date when="2012">2012</date><idno type="stanalyst">PASCAL 12-0393082 INIST</idno><idno type="RBID">Pascal:12-0393082</idno><idno type="wicri:Area/PascalFrancis/Corpus">000076</idno><idno type="wicri:Area/PascalFrancis/Curation">002C38</idno><idno type="wicri:Area/PascalFrancis/Checkpoint">000134</idno><idno type="wicri:doubleKey">0885-3185:2012:Montgomery E:microelectrode:targeting:of</idno><idno type="wicri:Area/Main/Merge">001113</idno><idno type="wicri:Area/Main/Curation">001061</idno><idno type="wicri:Area/Main/Exploration">001061</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a">Microelectrode Targeting of the Subthalamic Nucleus for Deep Brain Stimulation Surgery</title><author><name sortKey="Montgomery, Erwin B Jr" sort="Montgomery, Erwin B Jr" uniqKey="Montgomery E" first="Erwin B. Jr" last="Montgomery">Erwin B. Jr Montgomery</name><affiliation wicri:level="2"><inist:fA14 i1="01"><s1>Department of Neurology, University of Alabama at Birmingham</s1><s2>Birmingham, Alabama</s2><s3>USA</s3><sZ>1 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Alabama</region></placeName></affiliation></author></analytic><series><title level="j" type="main">Movement disorders</title><title level="j" type="abbreviated">Mov. disord.</title><idno type="ISSN">0885-3185</idno><imprint><date when="2012">2012</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">Movement disorders</title><title level="j" type="abbreviated">Mov. disord.</title><idno type="ISSN">0885-3185</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Deep brain stimulation</term><term>Microelectrode</term><term>Nervous system diseases</term><term>Parkinson disease</term><term>Subthalamic nucleus</term><term>Surgery</term><term>Targeting</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Maladie de Parkinson</term><term>Pathologie du système nerveux</term><term>Microélectrode</term><term>Ciblage</term><term>Noyau sousthalamique</term><term>Chirurgie</term><term>Stimulation cérébrale profonde</term></keywords><keywords scheme="Wicri" type="topic" xml:lang="fr"><term>Chirurgie</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Though microelectrode recordings likely increase the risks and costs of DBS, incremental improvement in accuracy may translate into improved outcomes that justify these risks and costs. Clinically based, controlled studies to resolve these issues are problematic. Until such studies are reported, physicians must rely on indirect evidence. The spatial variability of physiologically defined optimal targets, as determined by microelectrode recording (MER), necessary for targeting the STN was calculated. Study of the effectiveness of a MER algorithm was based on the number of penetrations required. The radius of the volume with a 99% chance of including the physiologically defined optimal target, based on 108 cases, was 4.5 mm. This is larger than the estimated radius of the DBS effect, which is variously estimated to be 2 to 3.9 mm. The 99% confidence radius in the plane orthogonal to the lead was 3.2 mm. In 70% of cases, the imaging-based trajectories corresponded to the physiologically defined optimal target. For the remaining 30% of cases, 70% required only a single additional MER tract. The radii of the 99% confidence volume and area may be larger than the effective radius of stimulation. Surveying within those volumes or areas is therefore necessary to assure that at least 99% of cases will cover the physiologically defined target. The MER algorithm was robust in detecting the physiologically defined optimal target. However, there are significant caveats in interpretation of the data.</div></front></TEI><affiliations><list><country><li>États-Unis</li></country><region><li>Alabama</li></region></list><tree><country name="États-Unis"><region name="Alabama"><name sortKey="Montgomery, Erwin B Jr" sort="Montgomery, Erwin B Jr" uniqKey="Montgomery E" first="Erwin B. Jr" last="Montgomery">Erwin B. Jr Montgomery</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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