Frameless robot-assisted pallidal deep brain stimulation surgery in pediatric patients with movement disorders: precision and short-term clinical results
Por:
Candela-Cantó SA, Vanegas-Grisales MI, Darling A, Ortigoza-Escobar JD, Alamar M, Muchart-Lopez J, Climent A, Ferrer Vidal-Barraquer E, Rumià J and Pérez-Dueñas B
Publicada:
1 oct 2018
Ahead of Print:
20 jul 2018
Resumen:
OBJECTIVE The purpose of this study was to verify the safety and accuracy of the Neuromate stereotactic robot for use in deep brain stimulation (DBS) electrode implantation for the treatment of hyperkinetic movement disorders in childhood and describe the authors' initial clinical results.
METHODS A prospective evaluation of pediatric patients with dystonia and other hyperkinetic movement disorders was carried out during the 1st year after the start-up of a pediatric DBS unit in Barcelona. Electrodes were implanted bilaterally in the globus pallidus internus (GPi) using the Neuromate robot without the stereotactic frame. The authors calculated the distances between the electrodes and their respective planned trajectories, merging the postoperative CT with the preoperative plan using VoXim software. Clinical outcome was monitored using validated scales for dystonia and myoclonus preoperatively and at 1 month and 6 months postoperatively and by means of a quality-of-life questionnaire for children, administered before surgery and at 6 months' follow-up. We also recorded complications derived from the implantation technique, "hardware," and stimulation.
RESULTS Six patients aged 7 to 16 years and diagnosed with isolated dystonia (DYT1 negative) (3 patients), choreo-dystonia related to PDE2A mutation (1 patient), or myoclonus-dystonia syndrome SGCE mutations (2 patients) were evaluated during a period of 6 to 19 months. The average accuracy in the placement of the electrodes was 1.24 mm at the target point. At the 6-month follow-up, patients showed an improvement in the motor (65%) and functional (48%) components of the Burke-Fahn-Marsden Dystonia Rating Scale. Patients with myoclonus and SGCE mutations also showed an improvement in action myoclonus (95%-100%) and in functional tests (50%-75%) according to the Unified Motor-Rating Scale. The Neuro-QOL score revealed inconsistent results, with improvement in motor function and social relationships but worsening in anxiety, cognitive function, and pain. The only surgical complication was medial displacement of the first electrode, which limited intensity of stimulation in the lower contacts, in one case.
CONCLUSIONS The Neuromate stereotactic robot is an accurate and safe tool for the placement of GPi electrodes in children with hyperkinetic movement disorders.
Filiaciones:
Candela-Cantó SA:
Departments of 1 Neurosurgery
Pediatric Movement Disorders Unit, Sant Joan de Déu Barcelona Children's Hospital, Universitat de Barcelona
Vanegas-Grisales MI:
Neuropediatrics, and
Pediatric Movement Disorders Unit, Sant Joan de Déu Barcelona Children's Hospital, Universitat de Barcelona
Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
Darling A:
Neuropediatrics, and
Pediatric Movement Disorders Unit, Sant Joan de Déu Barcelona Children's Hospital, Universitat de Barcelona
Ortigoza-Escobar JD:
Neuropediatrics, and
Pediatric Movement Disorders Unit, Sant Joan de Déu Barcelona Children's Hospital, Universitat de Barcelona
Alamar M:
Departments of 1 Neurosurgery
Pediatric Movement Disorders Unit, Sant Joan de Déu Barcelona Children's Hospital, Universitat de Barcelona
Muchart-Lopez J:
Diagnostic Imaging
Pediatric Movement Disorders Unit, Sant Joan de Déu Barcelona Children's Hospital, Universitat de Barcelona
Climent A:
Departments of 1 Neurosurgery
Neuropediatrics, and
Intraoperative Neurophysiology Unit, and
Pediatric Movement Disorders Unit, Sant Joan de Déu Barcelona Children's Hospital, Universitat de Barcelona
Ferrer Vidal-Barraquer E:
Departments of 1 Neurosurgery
Pediatric Movement Disorders Unit, Sant Joan de Déu Barcelona Children's Hospital, Universitat de Barcelona
Department of Neurosurgery, Hospital Clinic de Barcelona, Universitat de Barcelona
and
Rumià J:
Departments of 1 Neurosurgery
Pediatric Movement Disorders Unit, Sant Joan de Déu Barcelona Children's Hospital, Universitat de Barcelona
Department of Neurosurgery, Hospital Clinic de Barcelona, Universitat de Barcelona
and
Pérez-Dueñas B:
Neuropediatrics, and
Pediatric Movement Disorders Unit, Sant Joan de Déu Barcelona Children's Hospital, Universitat de Barcelona
Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
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