Darko Chudy

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61Acta Clin Croat. Vol. 51, (Suppl) No. 2, 2012 Over 40 000 patients were treated with deep brain stimula-tion over the world mainly for movement disorders. Stereo-tactic neurosurgical centers used microelectrode recording ormacrostimulation or both methods as a helpful neurophysi-ologic and neurologic tools for positioning the electrode inthe target as subthalamic nucleus (STN), globus palidus in-ternus (GPi) or thalamic nuclei. In our Department for neu-rosurgery we have done deep brain stimulation for movementdisorders on 25 patients and on 11 patients with vegetativestate (VS) and minimal conscious state (MCS). We are usingmacrostimulation only for positioning the electrodes in STNand for other targets we are using only imaging.The operation was performed under local anesthesia and se-dation for Parkinson disease and in general anesthesia fordystonia, vegetative state and minimal conscious state. Thetarget for VS and MCS was determined according to the an-terior and posterior commissure shown on T1 and T2 MRIand computed tomography (CT). Contiguous T1 weighted2-milimeter axial MR images were obtained day before sur-gery (1,5 T Siemens AG Avanto , Erlangen, Germany). Formovement disorder patients the target was selected accord-ing to the position of subthalamic nucleus on contiguousT2 weighted 1 mm axial MR images. Leksell coordinateframe G (Elekta AB, Stockholm, Sweden) was fixed to thepatient’s head with the base ring, which was aligned to Reid’sbaseline. The CT scan was acquired with 1.5 mm slices afterthe placement of the Leksell frame. The calculation of thetarget and trajectory was performed on the Frame Link Plan-ning Stealth Station (Medtronic, Minneapolis, Minnesota,USA). Coordinates from the Schaltenbrand Wahren Atlaswere used to approximate the target of centromedial parafas-cicular nucleus (CM-pf ). The length of AC PC line was 27millimeters and the target was 9 mm posterior to the mid-commissural point, 1 mm below the intercomissural lineand 3,5 mm lateral to the ventricular wall in a left hemi-sphere. For positioning of the subthalamic nucleus we usedmamilothalamic tract and nucleus rubber defined on T2weighted MR images as a neuroanatomical marker.The trajectory was aligned to avoid passing through ventri-cles and sulci. An 8 mm burr hole was drilled at the entrypoint determined by the planned trajectory. Blunt 1,5 mmin diameter radiofrequency probe with dynamic impen-dence monitoring (Elekta AB, Stockholm, Sweden) waspassed to a point 3 mm above the target point. Dynamicimpedance monitoring was used to detect that the probe didnot penetrate the ventricle. The radiofrequency probe waswithdrawn and the DBS 3387 electrode (Medtronic, Min-neapolis, Minnesota, USA) was immediately implanteddown the trajectory. Fibrin sealant was applied to the duraldefect around the electrode. The DBS electrode was thensecured to the skull with titanium plate.The postoperative CT scan was obtained with the Leksellframe to confirm the position of electrode. The Leksellframe was removed and the Soletra neurostimulator(Medtronic, Minneapolis, Minnesota, USA) was implanted.From 2008. to 2011. we done 13 patients with PD, four pa-tients with dystonia, 9 patients in vegetative state and twopatients in minimal conscious state. The mean follow up of13 PD patients was 8 months, maximum 2 years and min-imum 6 months the UPDRS for off medication and offstimulation was 48,5 and for off medication and on stimu-lation was 10 we have no postoperative hemorrhage, infec-tion or hardware complication. Two patients in MCS aftercontinuous stimulation during six months of CM-pf nucleienjoy the life with full recovery of consciousness and mostof the higher cognitive functions. 52nd International Neuropsychiatric Pula CongressDEEP BRAIN STIMULATION FOR MOVEMENT DISORDERAND VEGETATIVE STATE. TECHNICAL NOTEDarko Chudy  Clinical Hospital Centre, Dubrava, ZagrebDepartment of Neurosurgery, Head

Deep Brain Stimulation for Movement Disorder and Vegetative State

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