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  • 1
    Electronic Resource
    Electronic Resource
    Springer
    Acta neurochirurgica 133 (1995), S. 153-156 
    ISSN: 0942-0940
    Keywords: Stereotactic atlas ; basal ganglia ; thalamotomy ; neurostimulation ; computer
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Functional stereotactic operations are currently performed primarily for medically uncontrollable Parkinson's disease and pain. In contrast to the targets in neuro-oncology, those in functional Stereotaxy cannot be represented directly by modern imaging methods. The target co-ordinates must therefore be calculated with the aid of special stereotactic atlases. These are publications in which a model brain has been constructed from autopsy examinations on a number of brains, or the data obtained have been compiled in the form of tables and histograms on which the calculation is then based. The target can then be determined based on the classic stereotactic landmarks and reference lines, such as the anterior commissure (AC), the foramen of Monro (FM), the posterior commissure (PC) or the base line FM-PC or AC-PC and the height of thalamus, taking into account the interindividually different anatomical proportions. Since the computational procedures involve repetitious algorithms, it was obvious that such procedures should be run by a computer program. For the most common stereotactic targets, we have developed a computer program for data storage on the one hand and computation and graphic output on the other. The output can be displayed on the monitor and can also be plotted out on paper or overhead transparency. Calibrating between the program and printer renders a 1∶1 reproduction, i.e. the graph can be superimposed directly onto original x-rays or images from computed tomography or nuclear magnetic imaging. The graph can be plotted in the three dimensions of the Cartesian co-ordinate system. An additional dimension can be attained by simultaneously including and plotting the data from different atlases and thus from different authors, including one's own data. In addition to the information capacity which this system offers, it also makes possible a considerable reduction in the time for computing the target while at the same time increasing the reliability.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 0942-0940
    Keywords: Parkinson's disease ; essential tremor ; tremor ; movement disorder ; stereotaxy ; neurostimulation ; thalamus ; ventral intermediate nucleus
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Based on Benabid's experimental and clinical findings that low-frequency (50 Hz) electrical stimulation of the ventral intermediate thalamic nucleus may increase tremor, while higher frequencies (〉100 Hz) lead to suppression of the tremor, we implanted a stimulation electrode in 33 thalami among 27 patients. Six patients were implanted bilaterally. 23 suffered from Parkinson's disease, 4 from essential tremor. All patients had a drug-resistant tremor. The Vim target was calculated based on stereotactic ventriculography. An intra-operative neurophysiological target control was performed on all patients. After a monopolar (12 thalami) or quadripolar (21 thalami) lead was implanted we then connected it to a percutaneous extension lead. In the days following the surgery a test stimulation was performed. In all but one patient stimulation resulted in a suppression of the tremor. In a second procedure, a pulse generator (ITREL II; MEDTRONIC) was implanted and connected subcutaneously to the thalamic lead. After implantation of the pulse generator all patients stimulate chronically while some turn off the stimulator at night. In 21 thalami total suppression of tremor was observed, 6 showed major improvement, 4 only minor improvement. There was no significant effect on any other existing symptom of Parkinson's disease. Due to the proximity of Vim to the sensory thalamus the majority of the patients (27 thalami) report slight temporary paraesthesias when the pulse generator is turned on. Two report permanent paraesthesias when stimulation is on. In 4 cases a slight dysarthria occurs under stimulation. In 2 the dysarthria is marked. In one case dysequilibrium occurs under stimulation. All these side effects are reversible when stimulation is turned off. In 3 patients, the lead was displaced due to an insufficient lead fixation, thus making a second procedure necessary to correct the electrode position. We had one complication due to bleeding at the burr hole side. Follow-up ranges from 3 to 48 months. So far in no cases has the effect of stimulation worn off. In conclusion we regard Vim neurostimulation as an effective and safe alternative to conventional thalamotomy and recommend that it should be considered in cases in which drag therapy has failed to affect Parkinsonian or essential tremor. Moreover, we believe that this procedure is a less invasive and equally efficient alternative to classic thalamotomy and thus should be given preference.
    Type of Medium: Electronic Resource
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