Evolution of a surgical technique for posteroventral pallidotomy using CT/MR fusion and intraoperative macrostimulation

Cook, Raymond; Fracchia, G; Hoban, Peter; Joffe, R; O'sullivan, D. J.

doi:10.1016/s0967-5868(98)90196-5

Cited by 5 publications

(3 citation statements)

References 21 publications

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“…The anatomical target was a modification of the posteroventral pallidal (PVP) target popularized by Laitinen [14] . We have described this target previously [15] .…”

Section: Methodsmentioning

confidence: 99%

Deep Brain Stimulation of the Antero-Medial Globus Pallidus Interna for Tourette Syndrome

et al. 2014

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BackgroundWe have previously reported the results of Deep Brain Stimulation (DBS) of the antero-medial globus pallidus interna (GPi) for severe Tourette Syndrome (TS) in 11 patients. We extend this case series to 17 patients and a longer follow-up to a maximum of 46 months.Methods17 patients (14 male; mean age 29.1 years, range 17–51 years) with severe and medically intractable TS were implanted with Medtronic quadripolar electrodes bilaterally in the antero-medial GPi. The primary outcome measure was the Yale Global Tic Severity Scale (YGTSS). Secondary outcome measures included the Yale-Brown Obsessive Compulsive Scale, Hamilton Depression Rating Scale, Gilles de la Tourette Quality of Life Scale and Global Assessment of Functioning. Follow up was at one month, three months and finally at a mean 24.1 months (range 8–46 months) following surgery.ResultsOverall, there was a 48.3% reduction in motor tics and a 41.3% reduction in phonic tics at one month, and this improvement was maintained at final follow-up. 12 out of 17 (70.6%) patients had a>50% reduction in YGTSS score at final follow up. Only 8 patients required ongoing pharmacotherapy for tics post-surgery. Patients improved significantly on all secondary measures. Adverse consequences included lead breakage in 4 patients, infection (1), transient anxiety (2), dizziness (1), poor balance (1) and worsening of stuttering (1).ConclusionsThis case series provides further support that antero-medial GPi DBS is an effective and well tolerated treatment for a subgroup of severe TS, with benefits sustained up to 4 years.

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“…The anatomical target was a modification of the posteroventral pallidal (PVP) target popularized by Laitinen [14] . We have described this target previously [15] .…”

Section: Methodsmentioning

confidence: 99%

Deep Brain Stimulation of the Antero-Medial Globus Pallidus Interna for Tourette Syndrome

et al. 2014

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“…2 In brief, preoperative T1 weighted MR and localised computed tomography images are fused and registered to stereotactically defined MR images. The probe passage is represented graphically with respect to a Cosman Robert Wales head frame and computed tomographic and MR images.…”

Section: Neurosurgical Proceduresmentioning

confidence: 99%

“…The procedure is associated with amelioration of dyskinesia, 2-5 rigidity, 2-6 and bradykinesia. [2][3][4][5][6][7] A less consistent finding is reduction in tremor. [8][9] The impact of PVP on cognitive status is poorly documented and the literature is limited almost entirely to examining unilateral lesions.…”

mentioning

confidence: 99%

Neuropsychological sequelae of bilateral posteroventral pallidotomy

Turner

Reid²,

Homewood³

et al. 2002

Journal of Neurology, Neurosurgery &Amp; Psychiatry

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Objectives: To document the impact of bilateral posteroventral pallidotomy on cognitive status. Methods: 17 patients with Parkinson's disease were evaluated with a neuropsychological battery before and six months after bilateral pallidotomy. A comparison group (n = 8) was also assessed at six month intervals. Outcome variables were tests of memory, language, visuospatial function, attention, executive skills, and depression. Results: Despite a large number of variables studied, a significant postsurgical change was found only in performance of the tower of London task, a measure of planning abilities. The effect size of this change was larger than that of the comparison group, and a reliable change index score established that 5 of 13 surgical patients had statistically reliable reductions in planning performance. Conclusions: Patients with a young age of onset and long duration of Parkinson's disease who underwent bilateral pallidotomy had a relatively circumscribed reduction in neuropsychological functioning, being limited to motor planning efficiency. These data suggest that the cognitive role of the posteroventral globus pallidus is limited, at least in people with Parkinson's disease.

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