Journal
MOVEMENT DISORDERS
Volume 24, Issue 10, Pages 1538-1541Publisher
WILEY-LISS
DOI: 10.1002/mds.22663
Keywords
dystonia; deep brain stimulation; transcranial sonography; globus pallidus internus
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Deep brain stimulation (DBS) of the globus pallidus internus (GPi) is an effective treatment in primary dystonia. Its success depends on the implantation accuracy of the DBS electrode into the targeted GPi. Discrepancies of up to 4 mm between the initial target, selected on preoperative MRI, and the final DBS lead location are caused mainly by caudal brain shift that occurs once the cranium is open. Nowadays, transcranial sonography (TCS) can display echogenic deep brain structures with higher image resolution compared to MRI under clinical conditions. Here, we demonstrate for the first time the use of a contemporary clinical high-end TCS system for intraoperative monitoring of DBS electrode position. Herewith, a high-resolution real-time imaging of closely located microelectrodes and of the DBS lead through the intact skull is feasible. Simultaneous color-coded sonographic imaging of arteries near the anatomical target allows further intraoperative refinement of DBS lead positioning, simultaneously preventing hemorrhages. (C) 2009 Movement Disorder Society
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