Five years ago I posted a message about Cruise Missile Technology Turns Spinal, Brain Surgeries into outpatient procedures. I asked the rhetorical question, Can outpatient pallidotomies and thalamotomy be far behind?
That report introduced the novel idea of using a CT scan and software to manipulate a robotic arm for pinpoint radiation therapy in the spine, lungs and brain.
Drs Paul Francel, a neurosurgeon, and David Coffman, a nuclear radiologist, at the University of Oklahoma Health Sciences Center have published an article outlining the use of 3-D MRI images and a new software that allows the accurate localization of targets in the brain for palladotomies, thalamotomies and DBS implants.
The 3-D MRI images allow different views of the brain's structure and also blood and drainage supply, allowing the neurosurgeon to preplan the operation to avoid the risks inherent with conventional neurosurgery. The software does the trigonometry after showing the neurosurgeon a slice by slice view of what entry to the target area will encounter along the way.
Target localization is divided into two camps, those that use micro-electrode recording to pinpoint the optimal target for the ablation, for pallidotomy and thalamotomy, and those who use 3-D MRI and preplanning software.
Micro-electrode recording probes and stimulates surrounding areas of the general target in order to find the best final target. This practice adds hours to the time a patient is on the OR table. Teaching facilities prefer to use this method because they are training new prospective neurosurgeons who may not have had extensive training and it is a "show and tell" approach.
Dr. Francel has found, from his experience, that outcomes are not statistically different from using micro-electrode recording and the newest method of using 3-D MRI and surgical preplanning software.
It is not uncommon for bilateral procedures to take 9 to 12 hours on the operating table when micro-electrode recording is used to perhaps 4 hours for a bilateral DBS when the 3-D MRI and surgical preplanning software is used. The extra 5 to 7 hours can mean a lot to a Parkinson's patient pinned to the table off medications.
Discharge of the patient is the next morning after overnight monitoring in the neurosurgery unit.
Dr. Paul Francel has permitted P-I-E-N-O the permission to republish his, and Dr David Coffman's, article. It is located at:
http://parkinsons-information-exchange-network-online.com/archive/109a.html
It is a comprehensive article spanning several pages which can be easily navigated using the links at the top and bottom of each page.
John
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John Cottingham
