Mismatch between electrophysiologically defined and ventriculography based theoretical targets for posteroventral pallidotomy in Parkinson's disease
M Merelloa b, A Cammarotaa b, D Cerquettia, R C Leiguardab
a Movement Disorders
Section, Raul Carrea Institute for Neurological Research (FLENI),
Montañeses 2325, (1428) Buenos Aires, Argentina, b Department of Neurology
Correspondence to: Dr Marcelo Merello Mmerello{at}fleni.org.ar
Received 22 November
1999 and in revised form 20 June 2000;
Accepted 10 July
2000
OBJECTIVES
Over the
past few years many reports have shown that posteroventral pallidotomy
is an effective method for treating advanced cases of Parkinson's
disease. The main differences with earlier descriptions were the use of
standardised evaluation with new high resolution MRI studies and of
single cell microrecording which can electrophysiologically define the
sensorimotor portion of the internal globus pallidus (GPi). The present
study was performed on a consecutive series of 40 patients with
Parkinson's disease who underwent posteroventral pallidotomy to
determine localisation discrepancies between the ventriculography based
theoretical and the electrophysiologically defined target for
posteroventral pallidotomy.
METHODSThe tentative
location of the posteroventral GPi portion was defined according to the
proportional Talairach system. Single cell recording was performed in
all patients. The definitive target was chosen according to the
feasibility of recording single cells with GPi cell features, including
the presence of motor drive and correct identification of the internal
capsule and of the optic tract by activity recording and microstimulation.
RESULTSIn all 40 patients the electrophysiologically defined sensorimotor portion of the
GPi was lesioned, with significantly improved cardinal Parkinson's
disease symptoms as well as levodopa induced dyskinesias, without
damage to the internal capsule or optic tract. Significant differences
between the localisation of the ventriculography based theoretical
versus electrophysiological target were found in depth (p<0.0008) and
posteriority (p<0.04). No significant differences were found in
laterality between both approaches. Difference ranges were 8 mm for
laterality, 6.5 mm for depth, and 10 mm for posteriority.
CONCLUSIONSElectrophysiologically
defined lesion of GPi for posteroventral pallidotomy, shown to be
effective for treating Parkinson's disease, is located at a
significantly different site from the ventriculography based
theoretical target.
Keywords: pallidotomy; Parkinson's disease; microrecording; globus pallidus
© 2000 by Journal of Neurology, Neurosurgery, and Psychiatry
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