| Clinical Usefulness of Neurosurgery Simulator?? in Planning of Deep Brain Stimulation for Various Movement Disorders |
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Hyuk Min Kwon, In Bo Han, Ji Young Moon, Jin Woo Chang, Byung Soo Yoo, Ryoong Huh, Sang Sup Chung |
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Department of Neurosurgery, Bundang CHA Hospital, Pochon CHA Medical University, Seongnam, Korea Department of Neurosurgery, Yonsei University College of Medcine, Seoul, Korea Department of Electronics Engineering, Korea Polytechnic University, Siheung, Korea |
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| Abstract |
Objective
The Neurosurgery Simulator® is a surgical planning tool for stereotactic and functional neurosurgery, recently developed in Korea. We determined whether Neurosurgery Simulator® can provide accurate target localization of deep brain stimulation (DBS) electrode.
Methods
31 consecutive patients suffering from movement disorders underwent DBS electrode placement using Neurosurgery Simulator® (NSS®) between October 2003 and January 2007. STN DBS was performed in 16 patients with Parkinson’
s disease, Vim DBS in 7 patients with essential tremor and 2 patients with secondary tremor, and GPi DBS in 6 patients with
dystonia. The precise coordinates of surgical target are directly acquired by designating an anatomical lesion on the magnetic
resonance imaging (MRI) with NSS®. The correctness is confirmed again by examining the anatomical lesion with superimposing the Schaltenbrand-Wahren atlas on the image directly.
Results
The precise coordinates of surgical target is directly acquired by designating an anatomical lesion on the magnetic
resonance image with NSS® due to auto recognition algorithm of the fiducials on the MRI image. There was relatively little
variation in the location of the core of the lesion compared with planned target. The mean Vim coordinates were 14.8mm lateral to anterior commissure/posterior commissure (AC-PC) line, 6.7mm posterior to AC-PC midpoint and superior to ACPC line. The mean GPi coordinates were 21.5mm lateral to AC-PC line, 2.6mm anterior to AC-PC midpoint and 4.9mm
inferior to AC-PC line. The mean STN coordinates were 12.3mm lateral to AC-PC line, 2.3mm posterior to AC-PC midpoint
and 4.7mm inferior to AC-PC line. After placement of DBS electrode, significant improvement was achieved in all the patients. There was no deviation in guiding surgical trajectory. There were no significant surgical complications.
Conclusion
NSS® provides a simple and accurate method for the DBS electrode placement. |
| Key Words:
Deep brain stimulation, Neurosurgery simulator, Movement disorders, Accuracy. |
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