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Comparison of MRI-guided and ventriculography-based stereotactic surgery for Parkinson's disease

Estudo comparativo de cirurgia estereotáxica guiada por ressonância magnética e ventriculografia para doença de Parkinson

Abstracts

Stereotactic surgery for Parkinson's disease can be performed using different neuroimaging methods. Ventriculography has been used to locate the coordinates of the structures close to the third ventricle. Although it has several potential disadvantages related to the intraventricular injection of iodine contrast, it is considered a precise method. Computed tomography and magnetic resonance imaging have been used in some centers. In order to compare their efficacy, 50 stereotactic thalamotomies for Parkinson's disease were performed using either ventriculography (VE) (25) or magnetic resonance imaging (MRI) (25). In 14 out of 25 VE procedures, computed tomography (CT-scan) was also used and showed a significant mean difference of coordinate Y and Z. The clinical results employing either VE or MRI were similar, with 80% abolition of tremor in the VE group, and 84% in the MRI group, after a follow up period of at least 3 months. Another 12% of VE and 16% of MRI group showed significant improvement of tremor. Complication rate was 4% in both groups. MRI-guided stereotactic thalamotomy in Parkinson's disease has shown good clinical results, comparable to VE-guided stereotaxis.

stereotactic thalamotomy; Parkinson's disease; ventriculography; magnetic resonance imaging


A cirurgia estereotáxica para doença de Parkinson (DP) pode ser realizada com diferentes métodos de neuroimagem. A ventriculografia (VE) tem sido empregada para determinar as coordenadas estereotáxicas das estruturas próximas ao terceiro ventrículo. Apesar de várias desvantagens relacionadas com a injeção intraventricular de contraste iodado, é considerada como uma técnica precisa. A tomografia computadorizada (TC) e a ressonância magnética (RM) têm sido utilizadas em alguns centros. Para comparar a eficácia dos diferentes métodos, 50 talamotomias estereotáxicas para DP foram realizadas utilizando VE (25 casos) e RM (25 casos). Em 14, dos 25 casos com VE, o emprego concomitante de TC demonstrou diferença média importante nas coordenadas Y e Z. Os resultados clínicos utilizando-se VE ou RM foram similares, com 80% de abolição de tremor no grupo com VE e 84% com RM durante seguimento mínimo de 3 meses. Além disso, 12% do grupo com VE e 16% do grupo com RM apresentaram significativa melhora do tremor. índice de 4% de complicações foi encontrado em ambos os grupos. Não houve mortalidade. A talamotomia estereotáxica guiada por RM para DP demonstrou resultados comparáveis aos obtidos com VE.

talamotomia estereotáxica; doença de Parkinson; ventriculografia; ressonância magnética


Comparison of MRI-guided and ventriculography-based stereotactic surgery for Parkinson's disease

Estudo comparativo de cirurgia estereotáxica guiada por ressonância magnética e ventriculografia para doença de Parkinson

Murilo S. MenesesI; Walter O. ArrudaII; Sonival C. HunheviczI; Ricardo RaminaI; Ari A. PedrozoI; Mario H. TsubouchiII

IDepartments of Neurosurgery, Hospital das Nações, Curitiba PR, Brazil

IIDepartments of Neurology, Hospital das Nações, Curitiba PR, Brazil

ABSTRACT

Stereotactic surgery for Parkinson's disease can be performed using different neuroimaging methods. Ventriculography has been used to locate the coordinates of the structures close to the third ventricle. Although it has several potential disadvantages related to the intraventricular injection of iodine contrast, it is considered a precise method. Computed tomography and magnetic resonance imaging have been used in some centers. In order to compare their efficacy, 50 stereotactic thalamotomies for Parkinson's disease were performed using either ventriculography (VE) (25) or magnetic resonance imaging (MRI) (25). In 14 out of 25 VE procedures, computed tomography (CT-scan) was also used and showed a significant mean difference of coordinate Y and Z. The clinical results employing either VE or MRI were similar, with 80% abolition of tremor in the VE group, and 84% in the MRI group, after a follow up period of at least 3 months. Another 12% of VE and 16% of MRI group showed significant improvement of tremor. Complication rate was 4% in both groups. MRI-guided stereotactic thalamotomy in Parkinson's disease has shown good clinical results, comparable to VE-guided stereotaxis.

Key-words: stereotactic thalamotomy, Parkinson's disease, ventriculography, magnetic resonance imaging.

RESUMO

A cirurgia estereotáxica para doença de Parkinson (DP) pode ser realizada com diferentes métodos de neuroimagem. A ventriculografia (VE) tem sido empregada para determinar as coordenadas estereotáxicas das estruturas próximas ao terceiro ventrículo. Apesar de várias desvantagens relacionadas com a injeção intraventricular de contraste iodado, é considerada como uma técnica precisa. A tomografia computadorizada (TC) e a ressonância magnética (RM) têm sido utilizadas em alguns centros. Para comparar a eficácia dos diferentes métodos, 50 talamotomias estereotáxicas para DP foram realizadas utilizando VE (25 casos) e RM (25 casos). Em 14, dos 25 casos com VE, o emprego concomitante de TC demonstrou diferença média importante nas coordenadas Y e Z. Os resultados clínicos utilizando-se VE ou RM foram similares, com 80% de abolição de tremor no grupo com VE e 84% com RM durante seguimento mínimo de 3 meses. Além disso, 12% do grupo com VE e 16% do grupo com RM apresentaram significativa melhora do tremor. índice de 4% de complicações foi encontrado em ambos os grupos. Não houve mortalidade. A talamotomia estereotáxica guiada por RM para DP demonstrou resultados comparáveis aos obtidos com VE.

Palavras-chave: talamotomia estereotáxica, doença de Parkinson, ventriculografia, ressonância magnética.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

Aceite: 16-maio-1997.

Murilo S. Meneses, MD - Av. Getúlio Vargas 2159 - 80250-180 Curitiba PR - Brasil. FAX 55 41 342 5588.

  • 1. Asakura T, Uetsuhara K, Kanemaru R, Hirahara K. An applicability study on a CT-guided stereotactic technique for functional neurosurgery. Appl Neurophysiol 1985;48:73-76.
  • 2. Aziz T, Torrens M. CT-guided thalamotomy in the treatment of movement disorders. Br J Neurosurg 1989;3:333-336.
  • 3. Dogali M, Fazzini E, Kolodny et al. Stereotactic ventral pallidotomy for Parkinson's disease. Neurology 1995;45:753-761.
  • 4. Dormont D, Zerah M, Cornu P et al. A technique of measuring the precision of an MR-guided stereotaxic installation using anatomic specimens. Am J Neuroradiol 1994:15:365-371.
  • 5. Fahn S, Tolosa E, Marin C. Clinical rating scale for tremor. In Jankovic J, Tolosa E (eds). Parkinson's disease and movement disorders. Baltimore: William & Wilkins, 1993:271-280.
  • 6. Fox MW, Ahlskog JE, Kelly PJ. Stereotactic ventrolateralis thalamotomy for medically refractory tremor in post-levodopa era Parkinson's disease patients. J Neurosurg 1991;75:723-730.
  • 7. Gildenberg PL. The history of stereotactic neurosurgery. Neurosurg Clin N Am 1990:1:765-780.
  • 8. Grafton ST, Couldwell W, Lew MF et al. Pallidotomy increases movement-related activity in motor cortical areas in Parkinson's disease: a positron emission tomography imaging activation study. Ann Neurol 1994;36:315.
  • 9. Hariz MI. Correlation between clinical outcome and size and site of the lesion in computed tomography guided thalamotomy and pallidotomy. Stereotact Funct Neurosurg 1990,54/55:72-185.
  • 10. Hariz MI, Bergenheim AT, Fodstad H. Air-ventriculography provokes an anterior displacement of the third ventricle during functional stereotactic procedures. Acta Neurochir 1993;S123:147-152.
  • 11. Lacono RP, Shima F, Lonser RR et al. The results, indications, and physiology of posteroventral pallidotomy for patients with Parkinson's disease. Neurosurgery 1995;36:1118-1127.
  • 12. Kelly PJ. Comments on: Lunsford LD. Magnetic resonance imaging stereotactic thalamotomy: report of a case with comparison to computed tomography. Neurosurgery 1988;23:363-367.
  • 13. Kelly PJ. Response: Hariz MI, Bergenhein AT. Stereotactic thalamotomy. J Neurosurg 1992;76:891.
  • 14. Kelly PJ, Derome P, Guiot G. Thalamic spatial variability and the surgical results of lesions placed with neurophysiologic control. Surg Neurol 1978;9:307-315.
  • 15. Kondziolka D, Dempsey PK, Lunsford LD et al. A comparison between magnetic resonance imaging and computed tomography for stereotactic coordinate determination. Neurosurgery 1992;30:402-407.
  • 16. Laitinen LV. CT-guided ablative stereotaxis without ventriculography. Appl Neurophysiol 1985;48:18-21.
  • 17. Laitinen LV. Pallidotomy for Parkinson's disease. Neurosurg Clin N Am 1995;6:105-112.
  • 18. Laitinen LV, Bergenheim AT, Hariz MI. Ventroposterolateral pallidotomy in the treatment of Parkinson's disease. J Neurosurg 1992;76:53-61.
  • 19. Lehman RM, Hill RP. Computed-tomography-directed stereotaxis for movement disorder with postoperative magnetic resonance. Appl Neurophysiol 1988;51:21-28.
  • 20. Lévesque MF, Wilson CL, Behnke EJ et al. Accuracy of MR-guided stereotacticelectrode implantation. Stereotact Funct Neurosurg 1990;54:51-55.
  • 21. Lunsford LD, Martinez AJ, Latchaw RE. Stereotactic surgery with a magnetic resonance- and computerized tomography-compatible system. J Neurosurg 1986;64:872-878.
  • 22. Marks PV, Wild AM, Gleave JR. Long-term abolition of parkinsonian tremor following attempted ventriculography. Br J Neurosurg 1991;5:505-508.
  • 23. Marsden CD, Obeso JA. The functions of the basal ganglia and the paradox of stereotaxic surgery in Parkinson's disease. Brain 1994;117:877-897.
  • 24. Meuli RA, Verdun FR, Bochud FO et al. Assessment of MR image deformation for stereotactic neurosurgery using a tagging sequence. Am J Neuroradiol 1994;15:45-49.
  • 25. Ohye C, Shibazaki T, Hirai T et al. Further physiological observations on the ventralis intermedius neurons in the human thalamus. J Neurophysiol 1989;61:488-500.
  • 26. Rousseau J, Clarysse P, Blond S et al. Validation of a new method for stereotactic localization using MR imaging. J Comput Assist Tomogr 1991;15:291-296.
  • 27. Siegfried J. Therapeutic stereotactic procedures on the thalamus for motor movement disorders. Acta Neurochir 1993;124:14-18.
  • 28. Sumanaweera TS, Adler JR Jr., Napel S et al. Characterization of spatial distortion in magnetic resonance imaging and its implications for stereotactic surgery. Neurosurgery 1994;35:696-704.
  • 29. Wester K, Hauglie-Hanssen E. Stereotaxic thalamotomy: experiences from the levodopa era. J Neurol Neurosurg Psychiatry 1990;53:427-430.

Publication Dates

  • Publication in this collection
    18 Oct 2010
  • Date of issue
    Sept 1997
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