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PubMed · 8592221

Methods for microelectrode-guided posteroventral pallidotomy.

A Lozano·W Hutchison·Z Kiss·R Tasker·K Davis·J Dostrovsky
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Abstract

Methods for localizing the posteroventral globus pallidus intermus 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.

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Catheter AblationGlobus PallidusHumansMagnetic Resonance ImagingMicroelectrodesParkinson DiseasePostoperative ComplicationsStereotaxic TechniquesJournal Article

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A Lozano, W Hutchison, Z Kiss, R Tasker, K Davis, J Dostrovsky. 1996. Methods for microelectrode-guided posteroventral pallidotomy.. https://doi.org/10.3171/jns.1996.84.2.0194

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OBJECTIVES: This study is designed to examine the immediate and short-term outcomes of patients who have undergone slow pathway ablation/modification for atrioventricular nodal reentrant tachycardia. BACKGROUND: Targeting the slow pathway has emerged as the superior form of treatment for atrioventricular nodal reentrant tachycardia. This technique has been found effective and is associated with a low complication rate. However, little is known of the long-term outcome of patients undergoing this procedure. METHODS: Over a 40-month period the slow pathway was targeted in 379 consecutive patients with proven atrioventricular nodal reentrant tachycardia. The case records of all patients were examined. Accurate follow-up data is available in 96% of patients a mean of 20.6 months after the procedure. RESULTS: The initial success rate was 97%. The incidence of complete heart block was 0.8% and the mean fluoroscopy duration was 27.3 min. The recurrence rate was 6.9%. Age, number of pulses and fluoroscopy time were positively associated with either initial failure or recurrence. A total of 11.3% of patients were still taking antiarrhythmic medication at follow-up. CONCLUSIONS: Targeting the slow pathway is an effective form of treatment for atrioventricular nodal reentrant tachycardia. The technique has a high initial success rate, a low complication rate and a low recurrence rate at long-term follow-up. Slow pathway modification is associated with similar success rates and recurrence rates as slow pathway ablation and may confer theoretical long-term benefits.

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