Methods for microelectrode-guided posteroventral pallidotomy

Restricted access

✓ Methods for localizing the posteroventral globus pallidus internus are described. The authors' techniques include the use of microelectrodes to record single-unit activity and to microstimulate in human pallidum and its surrounding structures. This technique allows a precise determination of the locations of characteristic cell types in sequential trajectories through the external and internal segments of the pallidum. The location of the optic tract can be determined from microstimulation-evoked visual sensations and recordings of flash-evoked potentials. In addition, microstimulation-evoked motor and sensory responses allow the internal capsule to be identified. The data collected using this technique are an important adjunct to selecting optimum sites to place electrocoagulation lesions for stereotactic posteroventral pallidotomy for refractory Parkinson's disease.

Article Information

Address reprint requests to: William D. Hutchison, Ph.D., Department of Physiology, Medical Science Building, University of Toronto, Toronto, Ontario, M5S 1A8, Canada.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    A reconstruction of a microelectrode trajectory that traversed external globus pallidus (GPe), internal globus pallidus (GPi), and optic tract (OT). A: The trajectory through the pallidum is demonstrated on the sagittal brain map (from Schaltenbrand and Wahren atlas27) 20 mm lateral to midline. The trajectory has been adjusted to approximate the physiological data as shown in B; however, note that the physiological data still do not completely match the 20-mm lateral map. B: Reconstruction of the trajectory in A is shown with results of microelectrode recordings and stimulation. Thick lines represent the cellular areas and thin lines represent the acellular (quiet) regions. Receptive fields (RFs) are shown to the left of the line along with the depth of the recordings along the trajectory. Receptive fields are shown on figurines. The joints around which movement elicited modulation of cellular activity are circled. Projected fields (PFs), or the effects of microstimulation, are shown to the right of the line along with the current used. Stimulation was performed only at the bottom of the trajectory to help identify the OT (Vi = visual sensations). This example is somewhat unusual in that the patient did not have visual sensations with microstimulation at the depths at which recordings suggested the OT was present. C: Examples of typical cells recorded along this trajectory at each level of pallidum. One second of recording is shown for all except the OT recording that shows 0.1 second. For the OT, a single-pass recording is shown above the multisweep potential response to strobe light stimulation. The evoked potential is shown in the standard format of negative upward used for visual evoked potentials (VEPs). The stimulus artifact is the large vertical deflection at the beginning of the single-pass sweep. When this single-pass recording is amplified into an audible signal, the increase in baseline noise occurring at the 40-msec deflection of the VEPs can easily be heard. Note that the gain has been reduced in the lower GPe trace. AC = anterior commissure; PC = posterior commissure.

  • View in gallery

    Neurons in the globus pallidus (GP) respond to limb movements. Upper: The firing rate histogram illustrates the modulation of activity of a neuron in the external GP (GPe) to wrist flexion and extension. Lower: Histogram of discharge rate of a single unit in the internal GP (GPi) showing responses to wrist extension and flexion. In each case the upper two traces show electromyographic (EMG) activity of the wrist flexors and extensors. Bin widths are 100 msec.

  • View in gallery

    An example of the firing of a “tremor-cell” in the internal globus pallidus (GPi). Note that the discharge rate (lower trace) is responding to rest tremor in the arm.

  • View in gallery

    Postoperative magnetic resonance imaging confirming the internal globus pallidus lesion site in a patient with Parkinson's disease. This patient had a left ventral posterior pallidotomy 2 days earlier. Left: A T1-weighted image, coronal plane. Center: A T2-weighted image, sagittal plane. Right: Spoiled grass sequence, horizontal plane.

  • View in gallery

    Presumptive target for pallidotomy versus the actual (physiologically localized and most ventral) lesion site. Left: The location of Laitinen's suggested lesion site (2–3 mm anterior to the mid-commissural line, and 6 mm ventral to the anterior commissure—posterior commissure (AC—PC) line19) is shown on the 20 mm lateral sagittal Schaltenbrand and Wahren27 brain map as a filled rectangle. The map is standardized to an AC—PC length of 23 mm, and the grid of the stereotactic frame is shown accordingly. The line labelled “mcl” is the mid-commissural line. The location of our lesions based on microelectrode recording and stimulation is shown by the open circles. In most cases two lesions are made: the first is 3 to 4 mm above the most dorsal optic tract response and the second is 2 to 3 mm above the first. Right: Graph demonstrating the suggested target versus the actual lesion site (the most ventral if two lesions were made) with respect to the mid-commissural and AC—PC lines. The selection of lesion sites is based on physiology as described in Fig. 5left. In this case the grid is not standardized to a 23-mm AC—PC length. The large distribution of lesion sites demonstrates the significant variability in the location of globus pallidus internus (GPi) as determined by magnetic resonance—localized AC—PC coordinates. The physiologically determined location of GPi is more anterior and dorsal than predicted on the basis of anatomy alone.

References

1.

Albe-Fessard DArfel GGuiot Get al: Dérivations d'activités spontanées et évoquées dans les structures cérébrales profondes de l'homme. Rev Neurol 106:891051962Albe-Fessard D Arfel G Guiot G et al: Dérivations d'activités spontanées et évoquées dans les structures cérébrales profondes de l'homme. Rev Neurol 106:89–105 1962

2.

Bertrand GJasper HWong Aet al: Microelectrode recording during stereotactic surgery. Clin Neurosurg 16:3283561966Bertrand G Jasper H Wong A et al: Microelectrode recording during stereotactic surgery. Clin Neurosurg 16:328–356 1966

3.

Cooper IS: Intracerebral injection of procaine into the globus pallidus in hyperkinetic disorders. Science 119:4174191954Cooper IS: Intracerebral injection of procaine into the globus pallidus in hyperkinetic disorders. Science 119:417–419 1954

4.

DeLong MR: Activity of pallidal neurons during movement. J Neurophysiol 34:4144271971DeLong MR: Activity of pallidal neurons during movement. J Neurophysiol 34:414–427 1971

5.

DeLong MRCrutcher MDGeorgopoulos AP: Primate globus pallidus and subthalamic nucleus: functional organization. J Neurophysiol 53:5305431985DeLong MR Crutcher MD Georgopoulos AP: Primate globus pallidus and subthalamic nucleus: functional organization. J Neurophysiol 53:530–543 1985

6.

Dostrovsky JODavis KDLee Let al: Electrical stimulation-induced effects in the human thalamus. Adv Neurol 63:2192291993Dostrovsky JO Davis KD Lee L et al: Electrical stimulation-induced effects in the human thalamus. Adv Neurol 63:219–229 1993

7.

Dostrovsky JOSher GDDavis KDet al: Microinjection of lidocaine into human thalamus: a useful tool in stereotactic surgery. Stereotact Funct Neurosurg 60:1681741993Dostrovsky JO Sher GD Davis KD et al: Microinjection of lidocaine into human thalamus: a useful tool in stereotactic surgery. Stereotact Funct Neurosurg 60:168–174 1993

8.

Filion MTremblay L: Abnormal spontaneous activity of globus pallidus neurons in monkeys with MPTP-induced parkinsonism. Brain Res 547:1421511995Filion M Tremblay L: Abnormal spontaneous activity of globus pallidus neurons in monkeys with MPTP-induced parkinsonism. Brain Res 547:142–151 1995

9.

Filion MTremblay LBédard PJ: Abnormal influences of passive limb movement on the activity of globus pallidus neurons in parkinsonian monkeys. Brain Res 444:1651761991Filion M Tremblay L Bédard PJ: Abnormal influences of passive limb movement on the activity of globus pallidus neurons in parkinsonian monkeys. Brain Res 444:165–176 1991

10.

Filion MTremblay LBédard PJ: Effects of dopamine agonists on the spontaneous activity of globus pallidus neurons in monkeys with MPTP-induced parkinsonism. Brain Res 547:1521611995Filion M Tremblay L Bédard PJ: Effects of dopamine agonists on the spontaneous activity of globus pallidus neurons in monkeys with MPTP-induced parkinsonism. Brain Res 547:152–161 1995

11.

Gross CRougier ABoraud Tet al: Alleviation of motor sign of parkinson disease after stimulation of the internal segment of the globus pallidus: experimental evidence in human. Soc Neurosci Abstr 20:17791994 (Abstract)Gross C Rougier A Boraud T et al: Alleviation of motor sign of parkinson disease after stimulation of the internal segment of the globus pallidus: experimental evidence in human. Soc Neurosci Abstr 20:1779 1994 (Abstract)

12.

Guiot GBrion S: Traitement des mouvements anormaux par la coagulation pallidale. Technique et résultats. Rev Neurol 89:5785801953Guiot G Brion S: Traitement des mouvements anormaux par la coagulation pallidale. Technique et résultats. Rev Neurol 89:578–580 1953

13.

Guiot GHardy JAlbe-Fessard D: [Precise delimitation of the subcortical structures and identification of thalamic nuclei in man by stereotactic electrophysiology.] Neurochirurgia 51:1181962 (Fr)Guiot G Hardy J Albe-Fessard D: [Precise delimitation of the subcortical structures and identification of thalamic nuclei in man by stereotactic electrophysiology.] Neurochirurgia 51:1–18 1962 (Fr)

14.

Hassler RRiechert T: Indikationen and lokalisations-methode der gezielten Hirnoperationen. Nervenarzt 25:4414471954Hassler R Riechert T: Indikationen and lokalisations-methode der gezielten Hirnoperationen. Nervenarzt 25:441–447 1954

15.

Hubel DH: Tungsten microelectrodes for recording from single units. Science 125:5495501957Hubel DH: Tungsten microelectrodes for recording from single units. Science 125:549–550 1957

16.

Hutchison WDLozano AMKiss ZHTet al: Tremor-related activity (TRA) in globus pallidus of Parkinson's disease (PD) patients. Soc Neurosci 20:7831994 (Abstract)Hutchison WD Lozano AM Kiss ZHT et al: Tremor-related activity (TRA) in globus pallidus of Parkinson's disease (PD) patients. Soc Neurosci 20:783 1994 (Abstract)

17.

Hutchison WDLozano CADavis KDet al: Differential neuronal activity in segments of globus pallidus in Parkinson's disease patients. Neuroreport 5:153315371994Hutchison WD Lozano CA Davis KD et al: Differential neuronal activity in segments of globus pallidus in Parkinson's disease patients. Neuroreport 5:1533–1537 1994

18.

Jasper HHBertrand G: Thalamic units involved in somatic sensation and voluntary and involuntary movements in man in Purpura DPYahr MD (eds): The Thalamus. New York: Columbia University Press1966 pp 365390Jasper HH Bertrand G: Thalamic units involved in somatic sensation and voluntary and involuntary movements in man in Purpura DP Yahr MD (eds): The Thalamus. New York: Columbia University Press 1966 pp 365–390

19.

Laitinen LVBergenheim ATHariz MI: Leksell's posteroventral pallidotomy in the treatment of Parkinson's disease. J Neurosurg 76:53611992Laitinen LV Bergenheim AT Hariz MI: Leksell's posteroventral pallidotomy in the treatment of Parkinson's disease. J Neurosurg 76:53–61 1992

20.

Lenz FADostrovsky JOKwan HCet al: Methods for microstimulation and recording of single neurons and evoked potentials in the human central nervous system. J Neurosurg 68:6306341988Lenz FA Dostrovsky JO Kwan HC et al: Methods for microstimulation and recording of single neurons and evoked potentials in the human central nervous system. J Neurosurg 68:630–634 1988

21.

Loeb GEBak MJSalcman Met al: Parylene as a chronically stable, reproducible microelectrode insulator. IEEE Trans Biomed Eng 24:1211281977Loeb GE Bak MJ Salcman M et al: Parylene as a chronically stable reproducible microelectrode insulator. IEEE Trans Biomed Eng 24:121–128 1977

22.

Lozano AMLang AEGalvez-Jiminez Net al: GPi pallidotomy improves motor function in patients with Parkinson's disease. Lancet 346:138313861995Lozano AM Lang AE Galvez-Jiminez N et al: GPi pallidotomy improves motor function in patients with Parkinson's disease. Lancet 346:1383–1386 1995

23.

Millar J: Extracellular single and multiple unit recording with microelectrodes in Stamford JA (ed): Monitoring Neuronal Activity: A Practical Approach. Oxford: IRL Press at Oxford University Press1992 pp 127Millar J: Extracellular single and multiple unit recording with microelectrodes in Stamford JA (ed): Monitoring Neuronal Activity: A Practical Approach. Oxford: IRL Press at Oxford University Press 1992 pp 1–27

24.

Miller WCDeLong MR: Parkinsonian symptomatology. An anatomical and physiological analysis. Ann NY Acad Sci 515:2873021989Miller WC DeLong MR: Parkinsonian symptomatology. An anatomical and physiological analysis. Ann NY Acad Sci 515:287–302 1989

25.

Raeva SN: Unit activity of some deep nuclear structures of the human brain during voluntary movement in Somjen GG (ed): Neurophysiology Studied in Man. Amsterdam: Excerpta Medica1972 pp 6478Raeva SN: Unit activity of some deep nuclear structures of the human brain during voluntary movement in Somjen GG (ed): Neurophysiology Studied in Man. Amsterdam: Excerpta Medica 1972 pp 64–78

26.

Schaltenbrand GBailey P: Introduction to Stereotaxis with an Atlas of the Human Brain. Stuttgart: Thieme1959Schaltenbrand G Bailey P: Introduction to Stereotaxis with an Atlas of the Human Brain. Stuttgart: Thieme 1959

27.

Schaltenbrand GWahren W: Atlas for Stereotaxy of the Human Brain. Stuttgart: Thieme1977Schaltenbrand G Wahren W: Atlas for Stereotaxy of the Human Brain. Stuttgart: Thieme 1977

28.

Sterio DBerić ADogali Met al: Neurophysiological properties of pallidal neurons in Parkinson's disease. Ann Neurol 35:5865911994Sterio D Berić A Dogali M et al: Neurophysiological properties of pallidal neurons in Parkinson's disease. Ann Neurol 35:586–591 1994

29.

Svennilson ETorvik ALowe Ret al: Treatment of parkinsonism by stereotactic thermolesions in the pallidal region. A clinical evaluation of 81 cases. Acta Psychiatr Neurol Scand 35:3583771960Svennilson E Torvik A Lowe R et al: Treatment of parkinsonism by stereotactic thermolesions in the pallidal region. A clinical evaluation of 81 cases. Acta Psychiatr Neurol Scand 35:358–377 1960

30.

Tasker RRLenz FAYamashiro Ket al: Microelectrode techniques in localization of stereotactic targets. Neurol Res 9:1051121987Tasker RR Lenz FA Yamashiro K et al: Microelectrode techniques in localization of stereotactic targets. Neurol Res 9:105–112 1987

31.

Tomlinson FHJack CR JrKelly PJ: Sequential magnetic resonance imaging following stereotactic radiofrequency ventralis lateralis thalamotomy. J Neurosurg 74:5795841991Tomlinson FH Jack CR Jr Kelly PJ: Sequential magnetic resonance imaging following stereotactic radiofrequency ventralis lateralis thalamotomy. J Neurosurg 74:579–584 1991

32.

Umbach WEhrhardt KJ: Ableitungen mit Mikroelektroden in den Stammganglien des Menschen. Arch Psychiatr Nervenkr 207:1061131965Umbach W Ehrhardt KJ: Ableitungen mit Mikroelektroden in den Stammganglien des Menschen. Arch Psychiatr Nervenkr 207:106–113 1965

33.

Vitek JKaneoke YTurner Ret al: Neuronal activity in the internal (GPi) and external (GPe) segments of the globus pallidus (GP) of parkinsonian patients is similar to that in the MPTP-treated primate model of parkinsonism. Soc Neurosci Abstr 19:15841993 (Abstract)Vitek J Kaneoke Y Turner R et al: Neuronal activity in the internal (GPi) and external (GPe) segments of the globus pallidus (GP) of parkinsonian patients is similar to that in the MPTP-treated primate model of parkinsonism. Soc Neurosci Abstr 19:1584 1993 (Abstract)

34.

Wichmann TDeLong MR: Pathophysiology of parkinsonian motor abnormalities. Adv Neurol 60:53611993Wichmann T DeLong MR: Pathophysiology of parkinsonian motor abnormalities. Adv Neurol 60:53–61 1993

TrendMD

Cited By

Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 135 135 107
Full Text Views 119 119 9
PDF Downloads 36 36 2
EPUB Downloads 0 0 0

PubMed

Google Scholar