Hamani, C;
Lozano, AM;
Mazzone, PA;
Moro, E;
Hutchison, W;
Silburn, PA;
Zrinzo, L;
Alam, M;
Goetz, L;
Pereira, EAC;
et al.
Hamani, C; Lozano, AM; Mazzone, PA; Moro, E; Hutchison, W; Silburn, PA; Zrinzo, L; Alam, M; Goetz, L; Pereira, EAC; Rughani, A; Thevathasan, W; Aziz, T; Bloem, BR; Brown, P; Chabardes, S; Coyne, T; Foote, K; Garcia-Rill, E; Hirsch, EC; Okun, MS; Krauss, JK
(2016)
Pedunculopontine Nucleus Region Deep Brain Stimulation in Parkinson Disease: Surgical Techniques, Side Effects, and Postoperative Imaging.
Stereotactic and Functional Neurosurgery, 94 (5).
pp. 307-319.
ISSN 1423-0372
https://doi.org/10.1159/000449011
SGUL Authors: Pereira, Erlick Abilio Coelho
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Abstract
The pedunculopontine nucleus (PPN) region has received considerable attention in clinical studies as a target for deep brain stimulation (DBS) in Parkinson disease. These studies have yielded variable results with an overall impression of improvement in falls and freezing in many but not all patients treated. We evaluated the available data on the surgical anatomy and terminology of the PPN region in a companion paper. Here we focus on issues concerning surgical technique, imaging, and early side effects of surgery. The aim of this paper was to gain more insight into the reasoning for choosing specific techniques and to discuss shortcomings of available studies. Our data demonstrate the wide range in almost all fields which were investigated. There are a number of important challenges to be resolved, such as identification of the optimal target, the choice of the surgical approach to optimize electrode placement, the impact on the outcome of specific surgical techniques, the reliability of intraoperative confirmation of the target, and methodological differences in postoperative validation of the electrode position. There is considerable variability both within and across groups, the overall experience with PPN DBS is still limited, and there is a lack of controlled trials. Despite these challenges, the procedure seems to provide benefit to selected patients and appears to be relatively safe. One important limitation in comparing studies from different centers and analyzing outcomes is the great variability in targeting and surgical techniques, as shown in our paper. The challenges we identified will be of relevance when designing future studies to better address several controversial issues. We hope that the data we accumulated may facilitate the development of surgical protocols for PPN DBS.
Item Type: |
Article
|
Additional Information: |
This is the peer-reviewed but unedited manuscript version of the following article: Hamani C, Lozano A, M, Mazzone P, A, M, Moro E, Hutchison W, Silburn P, A, Zrinzo L, Alam M, Goetz L, Pereira E, Rughani A, Thevathasan W, Aziz T, Bloem B, R, Brown P, Chabardes S, Coyne T, Foote K, Garcia-Rill E, Hirsch E, C, Okun M, S, Krauss J, K, Pedunculopontine Nucleus Region Deep Brain Stimulation in Parkinson Disease: Surgical Techniques, Side Effects, and Postoperative Imaging. Stereotact Funct Neurosurg 2016;94:307-319. The final, published version is available at http://www.karger.com/?doi=10.1159/000449011 |
Keywords: |
Neurology & Neurosurgery |
SGUL Research Institute / Research Centre: |
Academic Structure > Molecular and Clinical Sciences Research Institute (MCS) |
Journal or Publication Title: |
Stereotactic and Functional Neurosurgery |
ISSN: |
1423-0372 |
Dates: |
Date | Event |
---|
1 November 2016 | Published | 12 October 2016 | Published Online | 8 August 2016 | Accepted |
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Publisher License: |
Publisher's own licence |
Projects: |
|
URI: |
https://openaccess.sgul.ac.uk/id/eprint/108305 |
Publisher's version: |
https://doi.org/10.1159/000449011 |
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