title: Measurement of tissue electrical impedance confirms stereotactically localized internal segment of the globus pallidus during surgery.
abstract: Lesions surgically made in the internal segment of the posteroventral globus pallidus (Gpi) reduce many medically intractable symptoms in patients with Parkinson's disease. The Gpi is localized for pallidotomy by stereotactic procedures. We sought to confirm the stereotactically localized Gpi segment by measuring impedance between the tip of an active electrode that was advanced toward the target and a remote reference electrode. A stereotactic instrument was used to place an active electrode in 53 conscious patients undergoing pallidotomy. The electrode was manually advanced slowly toward the Gpi segment by a microdrive. Impedance was measured every 10 mm initially and every 1 mm in the final 10 mm of the electrode's advancement, using an impedance monitor interconnected with a lesion generator. Measurements were continued for several millimeters after each patient's target was reached. Impedance values ranged from 250 to 350 ohms throughout of the electrode passage. Impedance increased by 25-35 ohms at 1-3 mm before the center of the target and then dropped abruptly when the electrode passed the target. Impedance values depended strongly on the electrode's configuration. The impedance measurement confirmed the location of each surgical target identified by stereotactic navigation. The accuracy of the impedance measurement is acceptable, and the procedure can be recommended as an aid to confirm the stereotactically localized Gpi during neurological surgery.
authors.affiliation: Department of Biomedical Engineering, Lerner Research Institute, The Cleveland Clinic Foundation, Cleveland, OH 44195, USA. siemiov@cesmtp.ccf.org
authors.forename: V
authors.initials: V
authors.lastname: Siemionow
authors.forename: G H
authors.initials: GH
authors.lastname: Yue
authors.forename: G H
authors.initials: GH
authors.lastname: Barnett
authors.forename: V
authors.initials: V
authors.lastname: Sahgal
authors.forename: M P
authors.initials: MP
authors.lastname: Heilbrun
mesh_terms: D000328:Adult; D000368:Aged; D004566:Electrodes; D004594:Electrophysiology / Q000295:instrumentation / Q000379:methods; D005260:Female; D005917:Globus Pallidus / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000503:physiopathology* / Q000601:surgery*; D013238:Stereotaxic Techniques; D014057:Tomography, X-Ray Computed