CT-Oriented Microrecording Guided Selective Thalamotomy

Abstract

A further trial of CT-oriented microrecording guided stereotactic selective thalamotomy was conducted at the Centra Internacional de Restauración Neurológica, Havana City as treatment of resting tremor in 11 patients with idiopathic Parkinson''s disease (PD), and in 3 other patients with intentional tremor associated with multisystemic atrophy and cerebral palsy. Three of the parkinsonian patients had undergone fetal mesencephalic tissue transplantation with significant improvement of the most debilitating symptoms of PD and stabilization of the motor state, but predominantly unilateral tremor had impaired them progressively despite increased levodopa doses. A Leksell frame was used with a novel surgical planning system and electrophysiological recordings to identify the optimal target point inside the ventralis intermedius. In all but 1 case, the tremor was totally arrested. No persistent complications were observed.

Personal-Computer-Based System for Three-Dimensional Anatomic-Physiological Correlations during Stereotactic and Functional Neurosurgery

“…The NDRS system has been successfully used in Spain and Cuba in more than 300 stereotactic and functional neurosurgeries (Vim thalamotomy, pallidotomy, subthalamotomy and deep brain chronic stimulation) to control different symptoms of Parkinson's disease and other involuntary movement disorders [3,18,23].…”

“…amplitude discrimination, signal integration and Fourier analysis) [3,18,19]. The user can identify the different brain structures and nuclei according to the recorded brain signals [23].…”

“…Since 1993 a PC-based system (the Neurosurgical Deep Recording System -NDRS) has been developed at the International Neurological Restorative Center in Cuba, with the purpose of replacing with a personal computer (PC), the complex electronic equipment for deep brain electrical activity recording, display and processing during stereotactic and functional neurosurgery [17][18][19].…”

Impact of Posterior GPi Pallidotomy on Leg Tremor in Parkinson’s Disease

“…In contrast, thalamotomy resulted in tremor abolition in 85-95% of patients [13][14][15]. Therefore, the therapeutic effects of pallidotomy in relieving parkinsonian tremor appear to be inferior to those of thalamotomy [16].…”

Functional lesional neurosurgery for tremor: back to the future?

“…The method and size of lesions reported in the literature is variable: for example, RF thalamic (VIM)83 and subthalamic lesions48 have been reported between 40 mm 3 and 60 mm 3 , lesions to the cZI have been reported at 18 mm 3 in size after 11 years of follow-up84 and lesions to the GPi 65.5 mm 3 at 4 months85 and 40 mm 3 after 4–6 months follow-up 86. Leucotome thalamic lesions have been reported around 400–500 mm 3 size without reporting side effects 87.…”