Journal Mobile Options
Table of Contents
Vol. 89, No. 2, 2011
Issue release date: April 2011
Stereotact Funct Neurosurg 2011;89:70–75
(DOI:10.1159/000323371)

Skewering the Subthalamic Nucleus via a Parietal Approach

Zrinzo L. · Holl E.M. · Petersen E.A. · Limousin P. · Foltynie T. · Hariz M.I.
Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, University College London, London, UK

Individual Users: Register with Karger Login Information

Please create your User ID & Password





Contact Information











I have read the Karger Terms and Conditions and agree.

To view the fulltext, please log in

To view the pdf, please log in

Abstract

Background/Aims: A frontal burr hole around the level of the coronal suture is the conventional entry point when performing subthalamic nucleus (STN) deep brain stimulation (DBS). However, alternative approaches may sometimes be necessary. Methods: We present a report of delayed hardware erosion through the scalp in the left frontal region after successful bilateral STN DBS for Parkinson’s disease. The left STN was retargeted via a parietal entry point. Results: Significant improvement in UPDRS motor score (59%) was obtained with bilateral stimulation 6 months after re-operation. The literature was examined for similar approaches and the rationale, risks and benefits of non-frontal entry points in functional neurosurgery were explored. Conclusion: Together with a brief review of STN anatomy, this report demonstrates that the parietal approach to the STN remains a viable option in addition to the more traditional frontal access.



Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

References

  1. Bejjani BP, Dormont D, Pidoux B, Yelnik J, Damier P, Arnulf I, Bonnet AM, Marsault C, Agid Y, Philippon J, Cornu P: Bilateral subthalamic stimulation for Parkinson’s disease by using three-dimensional stereotactic magnetic resonance imaging and electrophysiological guidance. J Neurosurg 2000;92:615–625.
  2. Tisch S, Zrinzo L, Limousin P, Bhatia KP, Quinn N, Ashkan K, Hariz M: Effect of electrode contact location on clinical efficacy of pallidal deep brain stimulation in primary generalised dystonia. J Neurol Neurosurg Psychiatry 2007;78:1314–1319.
  3. Hariz MI, Krack P, Alesch F, Augustinsson LE, Bosch A, Ekberg R, Johansson F, Johnels B, Meyerson BA, N’Guyen JP, Pinter M, Pollak P, von Raison F, Rehncrona S, Speelman JD, Sydow O, Benabid AL: Multicentre European study of thalamic stimulation for parkinsonian tremor: a 6-year follow-up. J Neurol Neurosurg Psychiatry 2008;79:694–699.
  4. Elias WJ, Sansur CA, Frysinger RC: Sulcal and ventricular trajectories in stereotactic surgery. J Neurosurg 2009;110:201–207.
  5. Foltynie T, Zrinzo L, Martinez-Torres I, Tripoliti E, Petersen E, Holl E, Aviles-Olmos I, Jahanshahi M, Hariz M, Limousin P: MRI-guided STN DBS in Parkinson’s disease without microelectrode recording: efficacy and safety. J Neurol Neurosurg Psychiatry 2010 (in press).
  6. Hariz MI, Krack P, Melvill R, Jorgensen JV, Hamel W, Hirabayashi H, Lenders M, Wesslen N, Tengvar M, Yousry TA: A quick and universal method for stereotactic visualization of the subthalamic nucleus before and after implantation of deep brain stimulation electrodes. Stereotact Funct Neurosurg 2003;80:96–101.
  7. Zrinzo L, van Hulzen AL, Gorgulho AA, Limousin P, Staal MJ, De Salles AA, Hariz MI: Avoiding the ventricle: a simple step to improve accuracy of anatomical targeting during deep brain stimulation. J Neurosurg 2009;110:1283–1290.
  8. Zrinzo LU, Hariz MI: Impedance recording in functional neurosurgery; in Lozano AM, Gildenberg PL, Tasker RR (eds): Textbook of Stereotactic and Functional Neurosurgery. Berlin, Springer, 2009, pp 1325–1330.
  9. Chen CC, Pogosyan A, Zrinzo LU, Tisch S, Limousin P, Ashkan K, Yousry T, Hariz MI, Brown P: Intraoperative recordings of local field potentials can help localize the subthalamic nucleus in Parkinson’s disease surgery. Exp Neurol 2006;198:214–221.
  10. Rezai AR, Finelli D, Nyenhuis JA, Hrdlicka G, Tkach J, Sharan A, Rugieri P, Stypulkowski PH, Shellock FG: Neurostimulation systems for deep brain stimulation: in vitro evaluation of magnetic resonance imaging-related heating at 1.5 Tesla. J Magn Reson Imaging 2002;15:241–250.
  11. Alberts JL, Hass CJ, Vitek JL, Okun MS: Are two leads always better than one: an emerging case for unilateral subthalamic deep brain stimulation in Parkinson’s disease. Exp Neurol 2008;214:1–5.
  12. Yousry TA, Schmid UD, Alkadhi H, Schmidt D, Peraud A, Buettner A, Winkler P: Localization of the motor hand area to a knob on the precentral gyrus. A new landmark. Brain 1997;120:141–157.
  13. Smith C: Levodopa dose equivalency, University of Birmingham Clinical Trials Unit [accessed 06/10/10]. Available from: http://www.pdmed.bham.ac.uk/investigators/documentation/C.Smith_LED_Review.ppt., 2010.
  14. Deligny C, Drapier S, Verin M, Lajat Y, Raoul S, Damier P: Bilateral subthalamotomy through DBS electrodes: a rescue option for device-related infection. Neurology 2009;73:1243–1244.
  15. Raoul S, Faighel M, Rivier I, Verin M, Lajat Y, Damier P: Staged lesions through implanted deep brain-stimulating electrodes: a new surgical procedure for treating tremor or dyskinesias. Mov Disord 2003;18:933–938.
  16. Alvarez L, Macias R, Guridi J, Lopez G, Alvarez E, Maragoto C, Teijeiro J, Torres A, Pavon N, Rodriguez-Oroz MC, Ochoa L, Hetherington H, Juncos J, DeLong MR, Obeso JA: Dorsal subthalamotomy for Parkinson’s disease. Mov Disord 2001;16:72–78.
  17. Guiot G: Treatment of parkinsonian syndromes by destruction of internal pallidum (in German). Neurochirurgia (Stuttg) 1958;1:94–98.
  18. Gillingham FJ, Watson WS, Donaldson AA, Naughton JA: The surgical treatment of parkinsonism. Br Med J 1960;2:1395–1402.
  19. Benabid AL, Minotti L, Koudsie A, de Saint Martin A, Hirsch E: Antiepileptic effect of high-frequency stimulation of the subthalamic nucleus (corpus luysi) in a case of medically intractable epilepsy caused by focal dysplasia: a 30-month follow-up: Technical case report. Neurosurgery 2002;50:1385–1392.
  20. Vonck K, Boon P, Achten E, De Reuck J, Caemaert J: Long-term amygdalohippocampal stimulation for refractory temporal lobe epilepsy. Ann Neurol 2002;52:556–565.
  21. Franzini A, Messina G, Marras C, Villani F, Cordella R, Broggi G: Deep brain stimulation of two unconventional targets in refractory non-resectable epilepsy. Stereotact Funct Neurosurg 2008;86:373–381.
  22. Parent A, Hazrati LN: Functional anatomy of the basal ganglia. II. The place of subthalamic nucleus and external pallidum in basal ganglia circuitry. Brain Res Brain Res Rev 1995;20:128–154.
  23. Hamani C, Saint-Cyr JA, Fraser J, Kaplitt M, Lozano AM: The subthalamic nucleus in the context of movement disorders. Brain 2004;127:4–20.
  24. Shink E, Bevan MD, Bolam JP, Smith Y: The subthalamic nucleus and the external pallidum: two tightly interconnected structures that control the output of the basal ganglia in the monkey. Neuroscience 1996;73:335–357.
  25. Schaltenbrand G, Wahren W: Atlas for Stereotaxy of the Human Brain, ed 2. Stuttgart, Thieme, 1977.
  26. Yelnik J, Bardinet E, Dormont D, Malandain G, Ourselin S, Tande D, Karachi C, Ayache N, Cornu P, Agid Y: A three-dimensional, histological and deformable atlas of the human basal ganglia. I. Atlas construction based on immunohistochemical and MRI data. Neuroimage 2007;34:618–638.
  27. Karachi C, Yelnik J, Tande D, Tremblay L, Hirsch EC, Francois C: The pallidosubthalamic projection: an anatomical substrate for non-motor functions of the subthalamic nucleus in primates. Mov Disord 2005;20:172–180.
  28. Aravamuthan BR, Muthusamy KA, Stein JF, Aziz TZ, Johansen-Berg H: Topography of cortical and subcortical connections of the human pedunculopontine and subthalamic nuclei. Neuroimage 2007;37:694–705.
  29. Abosch A, Hutchison WD, Saint-Cyr JA, Dostrovsky JO, Lozano AM: Movement-related neurons of the subthalamic nucleus in patients with Parkinson’s disease. J Neurosurg 2002;97:1167–1172.
  30. Richardson RM, Ostrem JL, Starr PA: Surgical repositioning of misplaced subthalamic electrodes in Parkinson’s disease: location of effective and ineffective leads. Stereotact Funct Neurosurg 2009;87:297–303.
  31. Mallet L, Schupbach M, N’Diaye K, Remy P, Bardinet E, Czernecki V, Welter ML, Pelissolo A, Ruberg M, Agid Y, Yelnik J: Stimulation of subterritories of the subthalamic nucleus reveals its role in the integration of the emotional and motor aspects of behavior. Proc Natl Acad Sci USA 2007;104:10661–10666.
  32. Coenen VA, Prescher A, Schmidt T, Picozzi P, Gielen FL: What is dorsolateral in the subthalamic nucleus? A topographic and anatomical consideration on the ambiguous description of today’s primary target for deep brain stimulation surgery. Acta Neurochir (Wien) 2008;150:1163–1165.
  33. Dormont D, Ricciardi KG, Tande D, Parain K, Menuel C, Galanaud D, Navarro S, Cornu P, Agid Y, Yelnik J: Is the subthalamic nucleus hypointense on T2-weighted images? A correlation study using MR imaging and stereotactic atlas data. AJNR Am J Neuroradiol 2004;25:1516–1523.
  34. Bejjani BP, Dormont D, Pidoux B, Yelnik J, Damier P, Arnulf I, Bonnet AM, Marsault C, Agid Y, Philippon J, Cornu P: Bilateral subthalamic stimulation for Parkinson’s disease by using three-dimensional stereotactic magnetic resonance imaging and electrophysiological guidance. J Neurosurg 2000;92:615–625.
  35. Schupbach M, Gargiulo M, Welter ML, Mallet L, Behar C, Houeto JL, Maltete D, Mesnage V, Agid Y: Neurosurgery in Parkinson’s disease: a distressed mind in a repaired body? Neurology 2006;66:1811–1816.
  36. Hooper AK, Okun MS, Foote KD, Haq IU, Fernandez HH, Hegland D, Robicsek SA: Venous air embolism in deep brain stimulation. Stereotact Funct Neurosurg 2009;87:25–30.
  37. Rohlfing T, Maurer CR Jr, Dean D, Maciunas RJ: Effect of changing patient position from supine to prone on the accuracy of a Brown-Roberts-Wells stereotactic head frame system. Neurosurgery 2003;52:610–618.
  38. Daniluk S, Davies KG, Novak P, Vu T, Nazzaro JM, Ellias SA: Isolation of the brain-related factor of the error between intended and achieved position of deep brain stimulation electrodes implanted into the subthalamic nucleus for the treatment of Parkinson’s disease. Neurosurgery 2009;64:374–382.


Pay-per-View Options
Direct payment This item at the regular price: USD 38.00
Payment from account With a Karger Pay-per-View account (down payment USD 150) you profit from a special rate for this and other single items.
This item at the discounted price: USD 26.50