Deep brain stimulation for dystonia. Surgical technique.
Stimulation electrodes are implanted under general anesthesia, without intra-operative electrophysiology or clinical testing, based only on stereotactic MRI and direct anatomical localization of the postero-ventro-basal GPi. We retrospectively analyzed the surgical procedure that has been designed and implemented in our center, using the Leksell G frame, for initiating deep brain stimulation in 65 dystonic patients. We report the surgical technique and the hardware and software complications. We recommend immediate postoperative stereotactic MRI under general anesthesia as a prerequisite to check the reliability of MR acquisition (magnet stability) and the exact localization of each electrode. This technique allowed us to reduce the duration of the operation to 4 h, including general anesthesia, frame fixation, MRI acquisition, implantation of two electrodes under radioscopic control, immediate postoperative stereotactic MRI and frame removal. Surgery-related morbidity was very low with a 0% hemorrhage rate and three delayed unilateral infections re-operated 6 months later. Hardware and software complications were rare. The advances in 3D-MR imaging permit the electrode implantation for deep brain stimulation without resorting to intraoperative localization techniques, which is especially helpful in children and for treating dystonia. The maximum follow-up period is 58 months (first case: November 1996). GPi stimulation has proven to be an effective treatment for most dystonic syndromes with particular efficacy in the disease due to the DYT1 mutation.
Coubes
Philippe
P
Department of Pediatric Neurosurgery (Research Group on Movement Disorders in Children), Centre Gui de Chauliac, Montpellier University Hospital, Montpellier, France. p-coubes@chu-montpellier.fr
Vayssiere
Nathalie
N
El Fertit
Hassan
H
Hemm
Simone
S
Cif
Laura
L
Kienlen
Jacques
J
Bonafe
Alain
A
Frerebeau
Philippe
P
D000293:Adolescent; D000328:Adult; D002648:Child; D004421:Dystonia / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D004599:Electric Stimulation Therapy / Q000295:instrumentation / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D013238:Stereotaxic Techniques / Q000295:instrumentation / Q000706:statistics & numerical data