Cortical Stimulation for Central Neuropathic Pain: 3-D Surface MRI for Easy Determination of the Motor Cortex

Herregodts, Patrick; Stadnik, Tadeusz; Ridder, Filip De; D’Haens, Jean

doi:10.1007/978-3-7091-9419-5_29

Cited by 70 publications

(35 citation statements)

References 3 publications

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“…Six of the 12 patients reported experiencing relief of pain during the first postoperative titration of the stimulator setting (Cases 1,2,4,5,8,and 12). In six patients stim-…”

Section: Details Of the 12 Patients Are Shown Inmentioning

confidence: 99%

“…Motor cortex stimulation for neuropathic pain 7 name and treatment number [1][2][3][4][5][6][7][8][9][10]). The treatments were double blinded.…”

Section: Neurosurgical Focus / Volume 11 / September 2001mentioning

confidence: 99%

“…Variable response rates related to various implantation techniques have been reported in patients with central and peripheral neuropathic pain. [1][2][3][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] Table 1 provides a summary of these reported cases and series, as well as details of the optimum stimulator settings and the overall long-term response to MCS. The evidence suggests that a positive response is achieved in 44 to 100% of MCS-treated patients.…”

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confidence: 99%

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Motor cortex stimulation for neuropathic pain

Smith

Joint²,

Schlugman³

et al. 2001

FOC

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“…Six of the 12 patients reported experiencing relief of pain during the first postoperative titration of the stimulator setting (Cases 1,2,4,5,8,and 12). In six patients stim-…”

Section: Details Of the 12 Patients Are Shown Inmentioning

confidence: 99%

“…Motor cortex stimulation for neuropathic pain 7 name and treatment number [1][2][3][4][5][6][7][8][9][10]). The treatments were double blinded.…”

Section: Neurosurgical Focus / Volume 11 / September 2001mentioning

confidence: 99%

mentioning

confidence: 99%

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Motor cortex stimulation for neuropathic pain

Smith

Joint²,

Schlugman³

et al. 2001

FOC

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“…Although intraoperative SSEP recordings had early become the standard procedure to localize the functional central sulcus and motor target, 7,18,28,33 the surgical approach was initially limited to a trephination or a burr hole in the "estimated motor area" 7,12,13,18,33,34 to reduce the invasiveness of the technique. A simple procedure involving a 3D MR image with an external reference grid was proposed to define the central area grossly.…”

Section: Stereotactic Image Guidancementioning

confidence: 99%

The Zeiss-MKM system for frameless image-guided approach in epidural motor cortex stimulation for central neuropathic pain

Pirotte

Voordecker²,

Joffroy³

et al. 2001

FOC

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Object Twelve patients (seven female, and five male, mean age 55.6 years) suffering from refractory central (ischemic/traumatic [eight cases]) and neuropathic pain (trigeminal neuropathy [four cases]) underwent surgery for the implantation of an epidural motor cortex stimulation (MCS) device in which the authors used a frameless neuronavigation system, the Zeiss-MKM microscope. Methods The authors assessed the spatial accuracy of the neuronavigation system and its potential contribution to improve the quality of targeting pain. In these patients, the positions of the central sulcus, defined by stereotactic magnetic resonance MR imaging, intraoperative somatosensory evoked potentials (SSEPs) and subdural visual verification, were correlated into the stereotactic neuronavigation planning procedure. The mean spatial accuracy of distance between (MR) imaging–defined and actual central sulcus was 2.4 mm (range 5–10 mm). The intraoperative SSEP-defined central sulcus was close to that defined by MR imaging (mean distance 6.4 mm). Although very precise, intra-operative SSEP recordings were impaired by artifacts and wave attenuation in six of the 12 patients. Stereotactic correlations between anatomical and functional data in the navigation system corrected final targeting in 10 of 12 cases. Pain relief was obtained in eight patients. Indeed, inappropriate targeting probably explains the reported variable success rate of MCS and certainly underestimates the actual efficacy. Conclusions Since intraoperative SSEP monitoring has, for many years, been considered the standard procedure to approach motor target, the development of an accurate stereotactic image guidance system could help to increase the efficacy of MCS on the alleviation of pain. The excellent spatial accuracy provided by the Zeiss-MKM navigation system allows precise data correlations that represent a remarkable means to validate functional MR imaging as an alternative to SSEP. The authors believe that developing stereotactic image guidance with such a navigation system could improve the success rate of MCS.

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“…The use of surface anatomical landmarks, scalp SSEPs, and computerized tomography and MR imaging-guided systems have all been reported. 1,3,7,8,13 Functional imaging information, such as that obtained using MEG, fMR imaging, and optical imaging, is now routinely integrated into many neurosurgical procedures, including tumor/arteriovenous malformation resection and epilepsy surgery. Sole reliance on anatomical criteria for determination of eloquent cortex has been shown to have limitations, and the integration of such functional imaging data is a useful adjunct in preoperative planning and risk assessment as well as for intraoperative guidance.…”

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confidence: 99%

Epidural motor cortex stimulation with functional imaging guidance

Mogilner

Rezai²

2001

FOC

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Chronic epidural motor cortex stimulation (MCS) has been shown to have promise in the treatment of patients with refractory deafferentation pain. Precise placement of the electrode over the motor cortex region corresponding to the area of pain is essential for the success of this procedure. Whereas standard anatomical landmarks have been used in the past in conjunction with image guidance, the use of functional brain imaging can be beneficial in the precise surgical planning. The authors report the use of functional imaging–guided frameless stereotactic surgery for epidural MCS. Five patients underwent MCS in which functional imaging guidance was used. Prior to surgery, patients underwent magnetic resonance (MR) imaging with skin fiducial markers placed on standard anatomical reference prints, followed by magnetoencephalography (MEG) mapping of the sensory and motor cortices. In two patients, functional MR imaging was also performed using a motor task paradigm. The functional imaging data were integrated into a frameless stereotactic database by using a three-dimensional coregistration algorithm. Subsequently, a frameless stereotactic craniotomy was performed using the integrated anatomical and functional imaging data for surgical planning. Intraoperative somatosensory evoked potentials (SSEPs) and direct stimulation were used to confirm the target and final placement of the electrode. Direct stimulation and SSEPs performed intraoperatively confirmed the accuracy of the functional imaging data. Trial periods of stimulation successfully reduced pain in three of the five patients who then underwent permanent internal placement of the system. At a mean 6-month follow up, these patients reported an average reduction in pain of 55% on a visual analog scale. The integration of functional and anatomical imaging data allows for precise and efficient surgical planning and may reduce the time necessary for intraoperative physiological verification.

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Cortical Stimulation for Central Neuropathic Pain: 3-D Surface MRI for Easy Determination of the Motor Cortex

Cited by 70 publications

References 3 publications

Motor cortex stimulation for neuropathic pain

Motor cortex stimulation for neuropathic pain

The Zeiss-MKM system for frameless image-guided approach in epidural motor cortex stimulation for central neuropathic pain

Epidural motor cortex stimulation with functional imaging guidance

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