Anderson Deep Brain Stimulation

Techniques and Practices
1. Auflage 2019
ISBN: 978-1-63853-528-7
Verlag: Thieme
Format: EPUB
Kopierschutz: 6 - ePub Watermark

E-Book, Englisch, 190 Seiten, ePub

The one-stop resource on deep brain stimulation for functional neurosurgeons!

Deep brain stimulation (DBS) is used to modulate dysfunctional circuits in the brain with stimulation pulses applied to specific target areas of the brain. Globally, DBS procedures have been most commonly performed for Parkinson's disease and essential tremor, but there are now new and growing research efforts studying DBS for psychiatric disorders and epilepsy.

written by the Society for Innovative Neuroscience in Neurosurgery along with Dr. William S. Anderson and distinguished experts presents the latest DBS approaches. The book begins with a history of DBS, general frame-based techniques, patient selection primarily for movement disorders, multidisciplinary collaboration, and ethical considerations. Subsequent chapters detail diverse technologies and disease-specific treatment for Parkinson's disease, essential tremor, dystonia, OCD, epilepsy, major depression, Tourette syndrome, emerging psychiatric indications, and pediatric applications.

Key highlights

• Lead placement techniques utilizing currently available customized platforms and robotics
• Microelectrode recording and image-based direct targeting with MRI and CT to enhance lead placement
• Lesioning methods including radiofrequency, and MR-guided focused ultrasound
• Discussion of recent innovations in tractography to delineate white matter tracts in the brain and closed loop stimulation

DBS has helped thousands of patients with intractable conditions, allowing for a programmable therapy with durable treatment effect. This remarkable guide provides the essentials for functional neurosurgeons to pursue intraoperative research opportunities in this growing subspecialty and incorporate DBS into clinical practice.

This book includes complimentary access to a digital copy o

Autoren/Hrsg.

Anderson, William S.

Fachgebiete

• Medizin | Veterinärmedizin Medizin | Public Health | Pharmazie | Zahnmedizin Klinische und Innere Medizin Neurologie, Klinische Neurowissenschaft
• Medizin | Veterinärmedizin Medizin | Public Health | Pharmazie | Zahnmedizin Chirurgie Neurochirurgie
• Medizin | Veterinärmedizin Medizin | Public Health | Pharmazie | Zahnmedizin Chirurgie Chirurgische Techniken

Inhaltsverzeichnis

Chapter 1: Introduction to Deep Brain Stimulation: History, Techniques, and Ethical Considerations
Chapter 2: Customized Platform-Based Stereotactic DBS Lead Placement Technique (FHC STarFix, Medtronic Nexframe, and Robotic System Placement)
Chapter 3: Microelectrode Recording Methods
Chapter 4: Intraoperative Imaging-Based Lead Implantation
Chapter 5: Lesioning Methods for Movement Disorders
Chapter 6: Computational Modeling and Tractography for DBS Targeting
Chapter 7: Closed-Loop Stimulation Methods: Current Practice and Future Promise
Chapter 8: Parkinson's Disease Application
Chapter 9: Essential Tremor Application
Chapter 10: Deep Brain Stimulation for Dystonia—Clinical Review and Surgical Considerations
Chapter 11: Deep Brain Stimulation for Obsessive Compulsive Disorder
Chapter 12: Deep Brain Stimulation in Epilepsy
Chapter 13: Deep Brain Stimulation in Major Depression
Chapter 14: Deep Brain Stimulation in Tourette Syndrome
Chapter 15: Deep Brain Stimulation for Emerging Psychiatric Indications
Chapter 16: Intraoperative Research during Deep Brain Stimulation Surgery
Chapter 17: Deep Brain Stimulation: Techniques and Practice for Pediatrics Indications
Chapter 18: Establishing a Deep Brain Stimulation Practice

Leseproben

1 Introduction to Deep Brain Stimulation: History, Techniques, and Ethical Considerations

Teresa Wojtasiewicz, Nir Lipsman, Jason Gerrard, Travis S. Tierney

Abstract

Deep brain stimulation (DBS) is a procedure that developed as a result of decades of work in stereotactic guidance, neurophysiology, and neuroanatomy. Now, DBS is a validated, Food and Drug Administration (FDA)-approved treatment for a number of neurological and psychiatric disorders including Parkinson’s disease, essential tremor, dystonia, obsessive compulsive disorder, and epilepsy. Further applications remain an area of ongoing investigation. Lesioning is once again regaining interest, particularly with development of minimally invasive techniques such as laser interstitial thermal therapy and trans-cranial focused ultrasound. There are several methods for lead placement and procedural techniques will continue to evolve with time. A multidisciplinary team is critical for optimal patient evaluation, target selection, and postoperative followup. Medical ethics is a key part of the multidisciplinary management, particularly in case of children, patients with psychiatric disorders, and patients who are severely debilitated from their movement disorders.

Keywords: deep brain stimulation, functional neurosurgery, ethics

1.1 Introduction

Over the past three decades, deep brain stimulation (DBS) has become a widely used treatment for a variety of conditions since Benabid and colleagues first popularized the technique for the treatment of tremor.1 Even before this, early neuromodulation studies targeted the hypothalamus and somatosensory thalamus, for treatment of pain disorders.2,3,4 High-frequency stimulation in the thalamus led to discovery that stimulation of the thalamus could reduce tremor.5,6,7 Further studies showed that modulation or ablation by lesioning had the potential to treat patients with movement disorders.8,9,10,11 DBS is now a validated, Food and Drug Administration (FDA)-approved treatment for neurological disorders including Parkinson’s disease, essential tremor, dystonia, obsessive compulsive disorder, and epilepsy. Additional applications in other conditions remain an area of active investigation. Stereotactic lesioning is regaining additional interest, particularly with development of minimally invasive techniques such as the Gamma Knife and MRI-guided focused ultrasound.12,13 DBS systems can now be implanted using several different methods, with a range of options of stereotactic frames, image-guided targeting, and intraoperative microelectrode recordings (MERs) and testing. There are now multiple hardware and software options available for use in DBS, including different leads and implanted generators. A multidisciplinary team is critical to decide who is an optimal surgical candidate and what treatment strategy will be most suited for individual patient. Multidisciplinary collaboration maximizes the chance of successful DBS through appropriate preoperative evaluation of potential surgical candidates and continued postoperative care after DBS hardware placement. Medical ethics is an important part of the multidisciplinary management, particularly in case of children, patients with psychiatric disorders, and patients who are severely debilitated from their movement disorders.

1.2 History of Deep Brain Stimulation

Electricity has been a captivating possibility in treatment of human disorders for centuries, beginning with the earliest descriptions of treatment of pain with torpedo fish in Greek and Egyptian medicine, and investigations of contractions in frog muscle by Galvani.14,15,16 For thousands of years, many civilizations believed that targeting the brain could treat spiritual and mental ailments. Examples range from the earliest attempts at trepanation to 15th century artistic renditions of extracting “mental stones” from unstable people.17 Interestingly, attempts at lesions of the brain predated an understanding of functional organization of the brain but electric stimulation was key to this knowledge. Anecdotal studies of pathology, such as the frontal lobe disconnection and behavior changes seen in the case of Phineas Gage, suggested that complex behaviors could be attributed to specific areas of the brain.17,18 Physicians such as Jean Bouillaud, Simon Aubertin, and Paul Broca observed, from cases of patients with aphasia, that speech could be localized to specific regions of the brain.19,20 These developments inspired researchers Gustav Fritsch and Eduard Hitzig, who proved localization theory by stimulating the exposed cortical surface in dogs and localizing motor and nonmotor functions of the brain.21 David Ferrier conducted further experiments in monkeys by localizing hearing, visual attention, and secondary motor areas.20,22 The first use of neurostimulation in a human patient is attributed to Roberts Barthelow who stimulated the parietal lobes in an awake patient with an erosive basal cell cancer in 1874, producing contralateral movements and, subsequently, seizures.23 Shortly after that, Sir Victor Horsley, a pioneer in many aspects of neurosurgery, published a case of electric stimulation of an occipital encephalocele in 1884 and he and other neurosurgeons began using cortical stimulation for functional mapping.16,24,25 Horsley would also subsequently perform the first movement disorder surgery in 1908, successfully treating a patient with hemiathetosis by resecting the precentral gyrus, which cured the movement disorder but caused hemiplegia.26

For the next few decades after Horsley’s resection of the precentral gyrus, attempts at treating movement disorders were aimed at interrupting the pyramidal motor tracts, but with a high degree of morbidity and mortality.15,16 Abnormalities in deep brain structures, including atrophy of basal ganglia, were identified in anatomic studies of patients with movement disorders, but the basal ganglia was thought to be a dangerous target and the physiology of basal ganglia circuits was not yet well understood.27 Dr. Meyers reported several approaches to the basal ganglia, including sectioning the ansa lenticularis, but these approaches were accompanied by a 12% mortality which he felt was unacceptable.28 Despite the complications accompanying an open surgical approach, Meyers’ contributions definitively demonstrated that basal ganglia lesions could effectively treat tremor without causing paralysis or coma. These notions challenged the prevailing dogma of Dandy who believed that encroachment into the basal ganglia always resulted in coma, and previous ideas that only lesions to the pyramidal tract could alleviate tremor. Meyers’ important observations set the stage for future stereotactic surgical methods in targeting extrapyramidal subcortical structures for the treatment of refractory movement disorders. Still working with an open approach to the descending tracts, Irving Cooper in 1952 inadvertently encountered and was forced to ligate the anterior choroidal artery while attempting a pedunculotomy.29 Serendipitously, the resultant choroidal infarct relieved tremor without causing hemiparesis.29 He was able to reproduce his results with anterior choroidal artery ligation, ascribing the benefit of this procedure to interruption of efferent pathways from the globus pallidus.30 Despite the well-known introduction of frame-based stereotaxy by Spiegel and Wycis in 1947, Cooper continued to create lesions in the basal ganglia and thalamus with an essentially free-hand method.31,32 Cooper’s approaches were intermittently successful and may have had a lower risk of complications than other prior open approaches. Though his work did little to advance technical refinements in the field of movement disorders surgery, his findings finally reduced further attacks on the descending cortical spinal tracts as a treatment for tremor.

Lesioning for psychiatric conditions also blossomed in the early to mid 20th century. Developments in neuroanatomy showed function could be localized to certain areas and anecdotal evidence of patients with frontal lobe damage and behavior changes led to a perception that psychopathology could be localized to the frontal lobes.17 A few early attempts at frontal lobe resection, such as Gottlieb Burckhardt’s report of six patients published in 1891 and Lodovicus Puusepp’s report of three patients he operated on in 1910, had high rates of mortality and low rates of success in alleviation of symptoms and did not inspire enthusiasm for psychosurgery.17,33,34 The era of psychosurgery would begin in earnest when, at the Second International Neurologic Congress in London in 1935, John Fulton and Carlyle Jacobsen presented results of chimpanzee experiments showing that frontal lobe resection reduced “frustration behavior” associated with not receiving an anticipated reward.35 The audience for this meeting included Walter Freeman and Antonio Egas Moniz, who were keen to clinically translate these results. Moniz, in collaboration with Almeida Lima, successfully performed the first frontal lobotomies to treat patients with psychosis, first with alcohol injections and subsequently with a new instrument—the leukotome.36 Soon after, Walter Freeman and James Watts would replicate Moniz’ lobotomy technique, finding that it was successful in treating psychosis and other disorders including...