Microelectrode-guided pallidotomy: Technical approach and its application in medically intractable Parkinson's disease

Jerrold L. Vitek, Roy A.E. Bakay, Takao Hashimoto, Yoshiki Kaneoke, Klaus Mewes, Jian Yu Zhang, David Rye, Philip Starr, Mark Baron, Robert Turner, Mahlon R. DeLong

Research output: Contribution to journalArticle

233 Citations (Scopus)

Abstract

Object. The authors describe the microelectrode recording and stimulation techniques used for localizing the caudal sensorimotor portion of the globus pallidus internus (GPi) and nearby structures (internal capsule and optic tract) in patients undergoing GPi pallidotomy. Methods. Localization is achieved by developing a topographic map of the abovementioned structures based on the physiological characteristics of neurons in the basal ganglia and the microexcitable properties of the internal capsule and optic tract. The location of the caudal GPi can be determined by 'form fitting' the physiological map on relevant planes of a stereotactic atlas. A sensorimotor map can be developed by assessing neuronal responses to passive manipulation or active movement of the limbs and orofacial structures. The internal capsule and optic tract, respectively, can be identified by the presence of stimulation-evoked movement or the patient's report of flashes or speckles of light that occur coincident with stimulation. The optic tract may also be located by identifying the neural response to flashes of light. The anatomical/physiological map is used to guide lesion placement within the sensorimotor portion of the pallidum while sparing nearby structures, for example, the external globus pallidus, nucleus basalis, optic tract, and internal capsule. The lesion location and size predicted by using physiological recording together with thin-slice high- resolution magnetic resonance imaging reconstructions of the lesion were confirmed in one patient on histological studies. Conclusions. These data provide important information concerning target identification for ablative or deep brain stimulation procedures in idiopathic Parkinson's disease and other movement disorders.

Original languageEnglish (US)
Pages (from-to)1027-1043
Number of pages17
JournalJournal of neurosurgery
Volume88
Issue number6
DOIs
StatePublished - Jun 1998

Fingerprint

Pallidotomy
Globus Pallidus
Microelectrodes
Internal Capsule
Parkinson Disease
Light
Deep Brain Stimulation
Atlases
Movement Disorders
Basal Ganglia
Extremities
Magnetic Resonance Imaging
Neurons
Optic Tract

Keywords

  • Globus pallidus
  • Microelectrode
  • Movement disorder
  • Pallidotomy
  • Parkinson's disease
  • Surgical ablative therapy

Cite this

Microelectrode-guided pallidotomy : Technical approach and its application in medically intractable Parkinson's disease. / Vitek, Jerrold L.; Bakay, Roy A.E.; Hashimoto, Takao; Kaneoke, Yoshiki; Mewes, Klaus; Zhang, Jian Yu; Rye, David; Starr, Philip; Baron, Mark; Turner, Robert; DeLong, Mahlon R.

In: Journal of neurosurgery, Vol. 88, No. 6, 06.1998, p. 1027-1043.

Research output: Contribution to journalArticle

Vitek, JL, Bakay, RAE, Hashimoto, T, Kaneoke, Y, Mewes, K, Zhang, JY, Rye, D, Starr, P, Baron, M, Turner, R & DeLong, MR 1998, 'Microelectrode-guided pallidotomy: Technical approach and its application in medically intractable Parkinson's disease', Journal of neurosurgery, vol. 88, no. 6, pp. 1027-1043. https://doi.org/10.3171/jns.1998.88.6.1027
Vitek, Jerrold L. ; Bakay, Roy A.E. ; Hashimoto, Takao ; Kaneoke, Yoshiki ; Mewes, Klaus ; Zhang, Jian Yu ; Rye, David ; Starr, Philip ; Baron, Mark ; Turner, Robert ; DeLong, Mahlon R. / Microelectrode-guided pallidotomy : Technical approach and its application in medically intractable Parkinson's disease. In: Journal of neurosurgery. 1998 ; Vol. 88, No. 6. pp. 1027-1043.
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