History of Stereotactic Surgery for Parkinson's Disease

Rm, Redfern

doi:10.3109/02688698909002807

Cited by 24 publications

(6 citation statements)

References 147 publications

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“…It has replaced various other methods such as the local injection of alcohol or chemicals, the inflation of balloons, the use of leukotomes, cooling of the probe, and the interstitial implantation of radionucleides. [14,33,36] Radiofrequency lesioning is regarded as superior to these methods because it allows better definition of the lesion by varying parameters such as the diameter of the electrode, the exposed length of the electrode tip, and modulation of the time and the temperature of the lesion making. The "predictability" of the lesion has been stressed, particularly with regard to experimental studies using egg white.…”

Section: Discussionmentioning

confidence: 99%

“…[11] Pallidotomy was a common procedure for treatment of PD and postencephalitic parkinsonism in the 1950s. [33,36] However, after thalamotomy was introduced by Hassler and Riechert in 1952, [15] it gradually replaced pallidotomy in the late 1950s and early 1960s for treatment of parkinsonian symptoms, mainly because it more consistently relieved tremor. With large lesions in the posteroventral globus pallidus internus (GPi) and GP externus (GPe), Leksell and coworkers [39] observed more beneficial results for tremor, as well as improvement of bradykinesia, which they described as proportional to the decrease of rigidity.…”

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confidence: 99%

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Microelectrode-guided posteroventral pallidotomy for treatment of Parkinson's disease: postoperative magnetic resonance imaging analysis

Krauss¹,

Desaloms²,

Lai³

et al. 1997

FOC

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The authors report the postoperative magnetic resonance (MR) imaging findings in 36 patients with advanced Parkinson's disease who underwent unilateral microelectrode-guided posteroventral pallidotomy. The lesions were placed within 1 mm of the ventral border of the globus pallidus internus (GPi) to include pallidothalamic outflow pathways. Sequential MR studies were obtained within 1 to 3 days postoperatively and at 6-month follow-up examination. Thirty-four (94%) of the 36 patients enjoyed sustained moderate or marked improvement of their parkinsonian symptoms 6 months postoperatively. Transient side effects occurred in five patients (14%), but there were no persistent complications. The pallidal radiofrequency lesions were prolate spheroid-shaped and were composed of three concentric zones in the early postoperative studies. The mean volume of the middle zone, corresponding to the area of hemorrhagic coagulation necrosis, was 44.4 +/- 17.6 mm3; the mean lesion volume as defined by the outer zone, corresponding to perilesional edema, was 262.2 +/− 111.6 mm3. Additional edema spreading to the internal capsule was noted in 32 of 34 cases and to the optic tract in 11 of 34 cases. In two patients small ischemic infarctions involving the corona radiata were found, and in one a venous infarction was detected. Ischemic infarction resulted in mild transient Broca's aphasia in one patient, but there was no detectable neurological deficit in the other two. The mean volume of late-phase (6 months) lesions was 22 +/− 28.8 mm3. In three patients no lesion was identified despite sustained clinical improvement. The lesion was located in the posteroventral GPi in all cases except in one patient in whom it was confined to the GP externus (GPe). This 49-year-old woman did not experience sustained benefit. The authors found no consistent correlations between lesion size and location and clinical outcome as measured by a global outcome score, the Unified Parkinson's Disease Rating Scale motor, activities of daily living, and bradykinesia “off” scores or rating of dyskinesias. Lesioning of pallidal and subpallidal pathways may contribute to the sustained clinical benefit in this series. Magnetic resonance imaging analysis showed that intraoperative microelectrode recording facilitated accurate placement of the lesion in this critical area.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Microelectrode-guided posteroventral pallidotomy for treatment of Parkinson's disease: postoperative magnetic resonance imaging analysis

Krauss¹,

Desaloms²,

Lai³

et al. 1997

FOC

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“…Since the introduction of stereotactic neurosurgery in humans by Spiegel et al [1] in 1947, neurosurgeons have been utilizing this method [2][3][4][5][6][7][8] to perform various surgical procedures on deep-seated intracranical structures with a minimally invasive approach, e.g. treatment of Parkinson's disease by radiofrequency (RF) lesioning of the globus pallidus [9][10][11][12][13][14][15][16][17][18][19][20][21][22].…”

Section: Introductionmentioning

confidence: 99%

Utilization of Impedance Measurements in Pallidotomy Using a Monopolar Electrode

Limonadi

Roberts²,

Darcey³

et al. 1999

Stereotact Funct Neurosurg

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Object: This study was performed to evaluate the reliability and utility of using monopolar impedance monitoring for estimation of the location of the thermocouple electrode during a pallidotomy procedure. Methods: In 26 patients, impedance profiles were measured at 2-mm intervals and anatomical boundaries were marked on postoperative MRI studies in 19 patients. The pattern of change in impedance as the electrode was towards the target coordinates in the globus pallidus was studied empirically in relation to MRI-defined anatomy and by electrical stimulations. The pattern of impedance change was of greater reliability than absolute impedance values. A drop in impedance was noted in 10 cases where the electrode entered the putamen or globus pallidus upon exiting the internal capsule, and in 9 of these this drop was measured before or at the distal boundary of the internal capsule. A variable pattern in the region of the base of the globus pallidus was observed, with 10 of 19 cases demonstrating a decrease and 8 cases an increase, consistent with the proximity of a CSF cistern in the former and the ansa lenticularis and optic tract in the latter. Simulations showed that the monopolar electrode was more sensitive to the approach of a boundary than the bipolar electrode. Conclusion: Our measurements and simulations suggest that a monopolar electrode could predict a nearby region of high or low impedance before penetrating it and a trend of decreasing impedance as the distal edge of the globus pallidus is approached.

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“…And indeed, only after it had been shown to be efficacious in psychosurgery was it used to treat symptoms in patients with Huntington’s chorea. With the neuroanatomical and neurophysiological knowledge available from the non-stereotactic basal ganglia surgeries for Parkinson’s disease by Russel Meyers (1905–1999), the stereotactic technique then was quickly used to target other subcortical areas, including the pallidum, the ansa lenticularis, the motor thalamus and their interconnecting pathways [30, 31]. …”

Section: Discussionmentioning

confidence: 99%

The Origins of Human Functional Stereotaxis: A Reappraisal

Rzesnitzek

Hariz

Krauss

2019

Stereotact Funct Neurosurg

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In order to shed light on the first application of human functional stereotactic neurosurgery, whether it was in the realm of movement disorders, as has been claimed repeatedly, or in the realm of psychiatry, a review of the original scholarly literature was conducted. Tracking and scrutinising original publications by Spiegel and Wycis, the pioneers of human stereotactic neurosurgery, it was found that its origin and the very incentive for its development and first clinical use were to avoid the side effects of frontal leucotomy. The first applications of functional stereotactic neurosurgery were in performing dorsomedial thalamotomies in psychiatric patients; it was only later that the stereotactic technique was applied in patients with chronic pain, movement disorders and epilepsy. Spiegel and Wycis’ first functional stereotactic operations were for obsessive-compulsive disorder, schizophrenia, and other psychiatric conditions.

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History of Stereotactic Surgery for Parkinson's Disease

Cited by 24 publications

References 147 publications

Microelectrode-guided posteroventral pallidotomy for treatment of Parkinson's disease: postoperative magnetic resonance imaging analysis

Microelectrode-guided posteroventral pallidotomy for treatment of Parkinson's disease: postoperative magnetic resonance imaging analysis

Utilization of Impedance Measurements in Pallidotomy Using a Monopolar Electrode

The Origins of Human Functional Stereotaxis: A Reappraisal

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