Comparison of 3-D stereoscopic MR imaging with pre and post lesion recording in pallidotomy.
OBJECTIVE
A quantitative on-line analysis of electrical activity in the pallidum of Parkinsonian patients has been developed to determine the focal point of lesioning. Additional recordings are made after the lesioning, to assess residual neural activity. A 3-D volume stereoscopic image system is proposed to display the complex anatomy and to superimpose the electrophysiological data into this system. The purpose of this study is to understand the complex pathophysiology in real-time anatomic/image space and determine the location and effect of lesioning residual energy sites.


METHODS
Thirty patients undergoing 41 pallidotomies are presented. Neuronal activity from the pallidum is recorded using a semi-microelectrode. Based on this activity, lesioning is performed. Post-lesion recordings are made to determine the necessity of additional lesioning. 3-D volume MR images are acquired pre and postoperatively and compared for accuracy of lesion sites. A 3-D stereoscopic image system has been developed to depict basal ganglia geometry in the last 5 patients. Electrophysiological data are superimposed on this image system to show the surgeon the virtual position of the electrode tip.


RESULTS
A stereoscopic 3-D volume MR image system has been developed. This system more efficiently and accurately visualizes and records the coordinates of high neural activity in the pallidum and post lesion residual activity. Post-lesion power analysis was carried out in 30 patients. Additional lesions were indicated in 8 and different trajectories in 6.


CONCLUSIONS
Real-time visualization of neural recording, both pre and post-lesioning during pallidotomy, facilitates the surgeon's understanding of the spatiotemporal relationships of pathophysiological properties within the globus pallidus.
Lehman
R M
RM
Division of Neurosurgery, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA.
Zheng
J
J
Hamilton
J L
JL
Micheli-Tzanako
E
E
D000328:Adult; D000368:Aged; D001931:Brain Mapping / Q000295:instrumentation; D004569:Electroencephalography / Q000295:instrumentation*; D005260:Female; D005917:Globus Pallidus / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000295:instrumentation*; D008279:Magnetic Resonance Imaging / Q000295:instrumentation*; D008297:Male; D008875:Middle Aged; D009862:Online Systems / Q000295:instrumentation; D010300:Parkinson Disease / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery; D012086:Reoperation; D012984:Software; D013238:Stereotaxic Techniques / Q000295:instrumentation*; D016896:Treatment Outcome