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Proceedings Paper

Imaging-intensive guidance with confirmatory physiological mapping for neurosurgery of movement disorders
Author(s): Haring J.W. Nauta; J. G. Bonnen; V. M. Soukup; A. Gonzalez; Mya C. Schiess
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Paper Abstract

Stereotactic surgery for movement disorders is typically performed using both imaging and physiologic guidance. However, different neurosurgical centers vary in the emphasis placed on either the imaging or the physiological mapping used to locate the target in the brain. The relative ease with which imaging data is acquired currently and the relative complexity and invasiveness associated with physiologic mapping prompted an evaluation of a method that seeks to maximize the imaging component of the guidance in order to minimize the need for the physiologic mapping. The evaluation was carried out in 37 consecutive stereotactic procedures for movement disorders in 28 patients. Imaging was performed with the patients in a stereotactic head frame. Imaging data from MRI in three planes, CT and positive contrast ventriculography was all referenced to this headframe and combined in a stereotactic planning computer. Physiologic definition of the target was performed by macroelectrode stimulation. Any discrepancy between the coordinates of the imaging predicted target and physiologically defined target was measured. The imaging- predicted target coordinates allowed the physiologically defined target to be reached on the first electrode penetration in 70% of procedures and within two penetrations in 92%. The mean error between imaging predicted and physiologically defined target position was 1.24 mm. Lesion location was confirmed by postoperative MRI. There were no permanent complications in this series. Functional outcomes were comparable to those achieved by centers mapping with multiple microelectrode penetrations. The findings suggest that while physiologic guidance remains necessary, the extent to which it is needed can be reduced by acquiring as much imaging information as possible in the initial stages of the procedure. These data can be combined and prioritized in a stereotactic planning computer such that the surgeon can take full advantage of the most reliable information from each imaging modality.

Paper Details

Date Published: 5 June 1998
PDF: 6 pages
Proc. SPIE 3262, Surgical-Assist Systems, (5 June 1998); doi: 10.1117/12.309475
Show Author Affiliations
Haring J.W. Nauta, Univ. of Texas Medical Branch at Galveston (United States)
J. G. Bonnen, Univ. of Texas Medical Branch at Galveston (United States)
V. M. Soukup, Univ. of Texas Medical Branch at Galveston (United States)
A. Gonzalez, Univ. of Texas Medical Branch at Galveston (United States)
Mya C. Schiess, Univ. of Texas Medical Branch at Galveston (United States)

Published in SPIE Proceedings Vol. 3262:
Surgical-Assist Systems
Roger Von Hanwehr M.D.; Marilyn Sue Bogner; Steven T. Charles M.D.; Abraham Katzir; Marilyn Sue Bogner; Steven T. Charles M.D.; James A. Harrington; Warren S. Grundfest M.D.; Louis S. Lome; Warren S. Grundfest M.D.; James A. Harrington; Abraham Katzir; Louis S. Lome; Michael W. Vannier M.D.; Roger Von Hanwehr M.D., Editor(s)

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