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A Prospective Randomized Comparison of CT and MRI Pre-operative Localization for Pallidotomy

Published online by Cambridge University Press:  02 December 2014

Christopher R. Honey  and
Robert A. Nugent
Christopher R. Honey
Affiliation:
Division of Neurosurgery, Department of Radiology, University of British Columbia, Vancouver, BC, Canada
Robert A. Nugent
Affiliation:
Division of Neurosurgery, Department of Radiology, University of British Columbia, Vancouver, BC, Canada
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Abstract

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Objective:

During the pallidotomy procedure, is pre-operative localization with MRI more accurate than CT and does it result in a significant difference in surgical outcome?

Methods:

Twenty-four Parkinson's Disease patients received a unilateral pallidotomy for their motor symptoms. Dyskinesia was scored pre- and six weeks postoperatively. All patients had a pre-operative CT scan and MRI to calculate the target co-ordinates. Patients were then randomly selected to proceed with either the CT or MRI coordinates. The final position for the lesion was determined with intraoperative macrostimulation and impedance measurements. The percentage improvement of dyskinesia was noted for each patient and the two groups compared by the Mann-Whitney test. The distance from the final target to the MRI and CT pre-operative co-ordinates were calculated for each patient. The mean distance for each modality was then compared by Student's t-test. The number of electrode repositionings was also recorded for each patient and the two groups compared by the nonparametric Mann-Whitney test.

Results:

Although the MRI co-ordinates were significantly (p<0.023) closer to the final target, this did not translate into a significant reduction in electrode repositionings. There was no significant difference in the improvement in dyskinesia between the two groups.

Conclusion:

The pre-operative MRI co-ordinates were significantly (p=0.023) closer to the final target than those from the CT. The potential advantages and disadvantages of both imaging modalities are reviewed. There was no significant difference in surgical outcome using either MRI or CT for pre-operative localization in pallidotomy.

Résumé:

RÉSUMÉ:Objectif:

Pendant la pallidotomie, la localisation préétoire par RMN est-elle plus prése que par CT scan et la méode de localisation a-t-elle un impact significatif sur le réltat de la chirurgie?

Méodes:

Vingt-quatre patients atteints de la maladie de Parkinson ont subi une pallidotomie unilatéle dont l’indication éit des symptô moteurs. La dyskinée a é éluéavant et six semaines aprèl’intervention. Tous les patients ont eu un CT scan et une RMN péétoire pour calculer les coordonné de la cible. On a ensuite séctionnéu hasard les patients dont on utiliserait les coordonné obtenues par l’une ou l’autre méode au moment de la chirurgie. La position finale de la léon a é dérminépar macrostimulation peropétoire et par des mesures d’impénce. Le pourcentage d’améoration de la dyskinée a é notéour chaque patient et les deux groupes ont é comparépar le test de Mann-Whitney. La distance de la cible finale aux coordonné préétoires obtenues par RMN et CT scan a é calculépour chaque patient. La distance moyenne pour chaque méode a ensuite é comparéau moyen d’un test de t de Student. Le nombre de repositionnements des éctrodes a élement é notéour chaque patient et comparéntre les deux groupes au moyen du test non paraméique de Mann-Whitney.

Réltats:

Bien que les coordonné obtenues par RMN aient é significativement plus rapproché (<.023) de la cible finale, ceci ne s’est pas traduit par une réction significative du nombre de repositionnements des éctrodes. Il n’y avait pas de diffénce significative dans l’améoration des dyskinées entre les deux groupes.

Conclusion:

Les coordonné préétoires obtenues par RMN éient significativement plus prè(<.023) de la cible finale que celle obtenues par CT scan. Les avantages et les dévantages possibles des deux méodes d’imagerie sont revues. Il n’y avait pas de diffénce significative dans le réltat chirurgical quand l’une ou l’autre méode de localisation avait é utiliséavant la pallidotomie.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 27 , Issue 3 , August 2000 , pp. 236 - 240
Copyright
Copyright © The Canadian Journal of Neurological 2000

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