Correlations between Clinical and Autoptic Findings in Stereotaxic Operations of Parkinsonism

Häßler, R.; Mundinger, F.; Riechert, T

doi:10.1159/000104040

Cited by 57 publications

(29 citation statements)

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“…However, detailed post-mortem studies performed by Hassler revealed that lesions associated with the best effect on Parkinsonian tremor could not be found within the nucleus ventralis intermedius but rather at the base of the ventro-lateral thalamus, and especially in the area where cerebello-thalamic projections (in particular dentato-thalamic fibers) entered the thalamus [25]. Similar observations have been made in postmortem studies performed after ventralis intermedius stimulation [12,18].…”

Section: Introductionmentioning

confidence: 53%

Deep brain stimulation in the subthalamic area is more effective than nucleus ventralis intermedius stimulation for bilateral intention tremor

Hamel

Herzog

Kopper

et al. 2007

Acta Neurochir (Wien)

138

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SummaryBackground. The ventro-lateral thalamus is the stereotactic target of choice for severe intention tremor. Nevertheless, the optimal target area has remained controversial, and targeting of the subthalamic area has been suggested to be superior.Patients and methods. Eleven patients with disabling intention tremor of different etiology (essential tremor (n ¼ 8), multiple sclerosis (n ¼ 2) and one with, spinocerebellar ataxia) were implanted bilaterally with DBS electrodes targeted to the ventro-lateral thalamus using micro-recording and micro-stimulation. Among five tracks explored in parallel optimal tracks were chosen for permanent electrode implantation. Postoperative tremor suppression elicited by individual electrode contacts was quantified using a lateralised tremor rating scale at least 3 months (in most patients >1 year) after implantation. The position of electrode contacts was determined retrospectively from stereotactic X-ray exams and by correlation of pre-and postoperative MRI.Results. In all patients, DBS suppressed intention tremor markedly. On average, tremor on the left and right side of the body was improved by 68% (AE19; standard deviation) and 73% (AE21), respectively. In most patients, distal electrode contacts located in the subthalamic area proved to be more effective than proximal contacts in the ventro-lateral thalamus. In stereotactic coordinates, the optimal site was located 12.7 mm (AE1.4; mean AE standard deviation) lateral, 7.0 (AE 1.6) mm posterior, and 1.5 (AE 2.0) mm ventral to the mid-commissural point. In general, the best contacts could be selected for permanent stimulation. Nevertheless, in some instances, more proximal contacts had to be chosen because of adverse effects (paraesthesiae, dysarthria, gait ataxia) which were more pronounced with bilateral stimulation resulting in slightly less tremor suppression on the left and right side of body (63 AE 18 and 68 AE 19%, respectively).Conclusion. Direct comparison of different stimulation sites in individual patients revealed that DBS in the subthalamic area is more effective in suppressing pharmacoresistant intention tremor than the ventro-lateral thalamus proper. Anatomical structures possibly involved in tremor suppression include cerebello-thalamic projections, the prelemniscal radiation, and the zona incerta.

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Section: Introductionmentioning

confidence: 53%

Deep brain stimulation in the subthalamic area is more effective than nucleus ventralis intermedius stimulation for bilateral intention tremor

Hamel

Herzog

Kopper

et al. 2007

Acta Neurochir (Wien)

138

View full text Add to dashboard Cite

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“…Size and site of stereotactic lesions for the treatment of movement disorders have been evaluated both at autopsy [1][2][3] and in computed tomography (CT) studies [4][5][6][7][8][9][10][11][12], A purposeful C T assessment of the site of the lesion would be to correlate it not only to the preoperative target coordinates, but also to the anatomical C T target point, i.e., a given nucleus, defined in relation to the ventricular landmarks in the actual C T study, which requires a postoperative C T study done under stereotactic conditions. Furthermore, in order to obtain a meaningful correlation between radiological findings and clinical results of sur gery, the stereotactic C T (SCT) study should be performed several months after surgery, when the edema around the lesion has disap peared, and the lesion has reached its final shape and size [3,12].…”

Section: Introductionmentioning

confidence: 99%

Correlation between Clinical Outcome and Size and Site of the Lesion in Computed Tomography Guided Thalamotomy and Pallidotomy

Hariz

1990

Stereotact Funct Neurosurg

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Fourteen thalamotomies and five pallidotomies were performed in 19 patients with hereditary intention tremor or Parkinson''s disease. The target coordinates were determined by a stereotactic computed tomography study using the Laitinen nonin-vasive stereoadapter. Surgery was done without ventriculography. The patients were assessed 3–12 months later. In a postoperative stereotactic computed tomography study, the positions of the thalamic and pallidal targets were marked, and the coordinates of the center of the lesion were measured in relation to these targets. The volume of the lesion was calculated. In 3 thalamic lesion patients, no lesion could be visualized. The size of the eleven visible thalamic lesions ranged from 4 to 75 mm³ (mean 26), and the size of the 5 pallidal lesions ranged from 28 to 150 mm³ (mean 67). On the average, the center of the lesion was 1.4 mm medial to the position of the anatomical target (p < 0.002). Neither size nor site of the lesion correlated with the clinical outcome.

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“…These results were replicated by others [181,187,188]. Also of note is the fact that Hassler et al thought they were operating on the thalamus at times but turned out to have lesioned the STN [184] linking once again the STN to MDs. The Vim was known to be involved in MDs and DBS on the Vim had been performed for MDs prior to 1987.…”

Section: Lozano Et Al Also Described Human Studies In 1996mentioning

confidence: 66%

“…Hassler et al compared clinical data with autopsy findings and concluded that lesioning the nucleus ventro-oralis anterior (VOa) and the nucleus ventro-oralis posterior (VOp) had a limited affect on rigidity [184]. They also concluded that lesioning the nucleus ventralis intermedius (Vim), was the best treatment for tre mor [159,[185][186][187].…”

Section: Lozano Et Al Also Described Human Studies In 1996mentioning

confidence: 99%

The Development of Deep Brain Stimulation for Movement Disorders

Greek¹

2012

J Clinic Res Bioeth

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The development of deep brain stimulation has revolutionized care for patients with movement disorders like Parkinson's disease. Many areas of science contributed to this technology but one area, the use of animal models, has been cited as vital. We review these claims as well as the history of the discoveries that eventually led to deep brain stimulation in an attempt to ascertain: 1) the contributions of animal models; 2) the contributions from humanbased research and observation; and the role of advances in the engineering, physics, and computer science. We distinguish between advances and discoveries that were, or at least appear to be, dependent on animal models and those where animals were involved but that could have occurred, and/or were occurring simultaneously, with humanbased research. We conclude that animal-based research played a role in defining gross anatomy in the 19 th and early 20 th centuries, but that essentially all subsequent advances were human-based or secondary to advances in the physical and applied sciences. This has historical, funding, and ethical implications as the development of deep brain stimulation is cited as an example of the importance of animal-based research and a reason for continued social and financial support of animal models in general as opposed to clinical research, other human-based research modalities, and the various disciplines of the physical and applied sciences.

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Correlations between Clinical and Autoptic Findings in Stereotaxic Operations of Parkinsonism

Cited by 57 publications

References 0 publications

Deep brain stimulation in the subthalamic area is more effective than nucleus ventralis intermedius stimulation for bilateral intention tremor

Deep brain stimulation in the subthalamic area is more effective than nucleus ventralis intermedius stimulation for bilateral intention tremor

Correlation between Clinical Outcome and Size and Site of the Lesion in Computed Tomography Guided Thalamotomy and Pallidotomy

The Development of Deep Brain Stimulation for Movement Disorders

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