Intraoperative electrophysiological monitoring determines the
final electrode position for pallidal stimulation in dystonia
patients

J 2023

Intraoperative electrophysiological monitoring determines the final electrode position for pallidal stimulation in dystonia patients

BALÁŽ, Marek, Jiří BÚŘIL, Tereza JURKOVÁ, Eva KORIŤÁKOVÁ, Dušan HRABOVSKÝ et. al.

Basic information

Original name

Intraoperative electrophysiological monitoring determines the final electrode position for pallidal stimulation in dystonia patients

Authors

BALÁŽ, Marek (703 Slovakia, belonging to the institution), Jiří BÚŘIL (203 Czech Republic, belonging to the institution), Tereza JURKOVÁ (203 Czech Republic, belonging to the institution), Eva KORIŤÁKOVÁ (203 Czech Republic, belonging to the institution), Dušan HRABOVSKÝ (703 Slovakia, belonging to the institution), Jonáš KUNST (203 Czech Republic, belonging to the institution), Petra BARTOVA (203 Czech Republic) and Jan CHRASTINA (203 Czech Republic, guarantor, belonging to the institution)

Edition

FRONTIERS IN SURGERY, SWITZERLAND, FRONTIERS MEDIA SA, 2023, 2296-875X

Other information

Language

English

Type of outcome

Článek v odborném periodiku

Field of Study

30212 Surgery

Country of publisher

Switzerland

Confidentiality degree

není předmětem státního či obchodního tajemství

References:

URL

Impact factor

Impact factor: 1.800 in 2022

RIV identification code

RIV/00216224:14110/23:00134639

Organization unit

Faculty of Medicine

DOI

http://dx.doi.org/10.3389/fsurg.2023.1206721

UT WoS

000998908800001

Keywords in English

deep brain stimulation; dystonia; globus pallidus internus; microrecordings; stereotaxy

Abstract

V originále

BackgroundBilateral deep brain stimulation (DBS) of the globus pallidus internus (GPi) is an effective treatment for refractory dystonia. Neuroradiological target and stimulation electrode trajectory planning with intraoperative microelectrode recordings (MER) and stimulation are used. With improving neuroradiological techniques, the need for MER is in dispute mainly because of the suspected risk of hemorrhage and the impact on clinical post DBS outcome.ObjectiveThe aim of the study is to compare the preplanned GPi electrode trajectories with final trajectories selected for electrode implantation after electrophysiological monitoring and to discuss the factors potentially responsible for differences between preplanned and final trajectories. Finally, the potential association between the final trajectory selected for electrode implantation and clinical outcome will be analyzed.MethodsForty patients underwent bilateral GPi DBS (right-sided implants first) for refractory dystonia. The relationship between preplanned and final trajectories (MicroDrive system) was correlated with patient (gender, age, dystonia type and duration) and surgery characteristics (anesthesia type, postoperative pneumocephalus) and clinical outcome measured using CGI (Clinical Global Impression parameter). The correlation between the preplanned and final trajectories together with CGI was compared between patients 1-20 and 21-40 for the learning curve effect.ResultsThe trajectory selected for definitive electrode implantation matched the preplanned trajectory in 72.5% and 70% on the right and left side respectively; 55% had bilateral definitive electrodes implanted along the preplanned trajectories. Statistical analysis did not confirm any of the studied factors as predictor of the difference between the preplanned and final trajectories. Also no association between CGI and final trajectory selected for electrode implantation in the right/left hemisphere has been proven. The percentages of final electrodes implanted along the preplanned trajectory (the correlation between anatomical planning and intraoperative electrophysiology results) did not differ between patients 1-20 and 21-40. Similarly, there were no statistically significant differences in CGI (clinical outcome) between patients 1-20 and 21-40.ConclusionThe final trajectory selected after electrophysiological study differed from the preplanned trajectory in a significant percentage of patients. No predictor of this difference was identified. The anatomo-electrophysiological difference was not predictive of the clinical outcome (as measured using CGI parameter).

Links

NV19-04-00343, research and development project

Name: Predikce Efektu Stimulace u pacientů s Epilepsií (PRESEnCE) (Acronym: PRESEnCE)

Investor: Ministry of Health of the CR

Citovat

BALÁŽ, Marek, Jiří BÚŘIL, Tereza JURKOVÁ, Eva KORIŤÁKOVÁ, Dušan HRABOVSKÝ, Jonáš KUNST, Petra BARTOVA and Jan CHRASTINA. Intraoperative electrophysiological monitoring determines the final electrode position for pallidal stimulation in dystonia patients. FRONTIERS IN SURGERY. SWITZERLAND: FRONTIERS MEDIA SA, 2023, vol. 10, May 2023, p. 1-11. ISSN 2296-875X. Available from: https://dx.doi.org/10.3389/fsurg.2023.1206721.

@article{2296043,
   author = {Baláž, Marek and Búřil, Jiří and Jurková, Tereza and Koriťáková, Eva and Hrabovský, Dušan and Kunst, Jonáš and Bartova, Petra and Chrastina, Jan},
   article_location = {SWITZERLAND},
   article_number = {May 2023},
   doi = {http://dx.doi.org/10.3389/fsurg.2023.1206721},
   keywords = {deep brain stimulation; dystonia; globus pallidus internus; microrecordings; stereotaxy},
   language = {eng},
   issn = {2296-875X},
   journal = {FRONTIERS IN SURGERY},
   title = {Intraoperative electrophysiological monitoring determines the final electrode position for pallidal stimulation in dystonia patients},
   url = {https://www.frontiersin.org/articles/10.3389/fsurg.2023.1206721/full},
   volume = {10},
   year = {2023}
}

TY  - JOUR
ID  - 2296043
AU  - Baláž, Marek - Búřil, Jiří - Jurková, Tereza - Koriťáková, Eva - Hrabovský, Dušan - Kunst, Jonáš - Bartova, Petra - Chrastina, Jan
PY  - 2023
TI  - Intraoperative electrophysiological monitoring determines the final electrode position for pallidal stimulation in dystonia patients
JF  - FRONTIERS IN SURGERY
VL  - 10
IS  - May 2023
SP  - 1-11
EP  - 1-11
PB  - FRONTIERS MEDIA SA
SN  - 2296875X
KW  - deep brain stimulation
KW  - dystonia
KW  - globus pallidus internus
KW  - microrecordings
KW  - stereotaxy
UR  - https://www.frontiersin.org/articles/10.3389/fsurg.2023.1206721/full
N2  - BackgroundBilateral deep brain stimulation (DBS) of the globus pallidus internus (GPi) is an effective treatment for refractory dystonia. Neuroradiological target and stimulation electrode trajectory planning with intraoperative microelectrode recordings (MER) and stimulation are used. With improving neuroradiological techniques, the need for MER is in dispute mainly because of the suspected risk of hemorrhage and the impact on clinical post DBS outcome.ObjectiveThe aim of the study is to compare the preplanned GPi electrode trajectories with final trajectories selected for electrode implantation after electrophysiological monitoring and to discuss the factors potentially responsible for differences between preplanned and final trajectories. Finally, the potential association between the final trajectory selected for electrode implantation and clinical outcome will be analyzed.MethodsForty patients underwent bilateral GPi DBS (right-sided implants first) for refractory dystonia. The relationship between preplanned and final trajectories (MicroDrive system) was correlated with patient (gender, age, dystonia type and duration) and surgery characteristics (anesthesia type, postoperative pneumocephalus) and clinical outcome measured using CGI (Clinical Global Impression parameter). The correlation between the preplanned and final trajectories together with CGI was compared between patients 1-20 and 21-40 for the learning curve effect.ResultsThe trajectory selected for definitive electrode implantation matched the preplanned trajectory in 72.5% and 70% on the right and left side respectively; 55% had bilateral definitive electrodes implanted along the preplanned trajectories. Statistical analysis did not confirm any of the studied factors as predictor of the difference between the preplanned and final trajectories. Also no association between CGI and final trajectory selected for electrode implantation in the right/left hemisphere has been proven. The percentages of final electrodes implanted along the preplanned trajectory (the correlation between anatomical planning and intraoperative electrophysiology results) did not differ between patients 1-20 and 21-40. Similarly, there were no statistically significant differences in CGI (clinical outcome) between patients 1-20 and 21-40.ConclusionThe final trajectory selected after electrophysiological study differed from the preplanned trajectory in a significant percentage of patients. No predictor of this difference was identified. The anatomo-electrophysiological difference was not predictive of the clinical outcome (as measured using CGI parameter).
ER  -

BALÁŽ, Marek, Jiří BÚŘIL, Tereza JURKOVÁ, Eva KORIŤÁKOVÁ, Dušan HRABOVSKÝ, Jonáš KUNST, Petra BARTOVA and Jan CHRASTINA. Intraoperative electrophysiological monitoring determines the final electrode position for pallidal stimulation in dystonia patients. \textit{FRONTIERS IN SURGERY}. SWITZERLAND: FRONTIERS MEDIA SA, 2023, vol.~10, May 2023, p.~1-11. ISSN~2296-875X. Available from: https://dx.doi.org/10.3389/fsurg.2023.1206721.

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