Combination of functional magnetic resonance imaging-guided neuronavigation and intraoperative cortical brain mapping improves targeting of motor cortex stimulation in neuropathic pain.

Détails

ID Serval
serval:BIB_03C32B67A1A2
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
Combination of functional magnetic resonance imaging-guided neuronavigation and intraoperative cortical brain mapping improves targeting of motor cortex stimulation in neuropathic pain.
Périodique
Neurosurgery
Auteur⸱e⸱s
Pirotte B., Voordecker P., Neugroschl C., Baleriaux D., Wikler D., Metens T., Denolin V., Joffroy A., Massager N., Brotchi J., Levivier M.
ISSN
1524-4040 (Electronic)
ISSN-L
0148-396X
Statut éditorial
Publié
Date de publication
2005
Peer-reviewed
Oui
Volume
56
Numéro
2 Suppl.
Pages
344-359
Langue
anglais
Notes
Publication types: Journal Article
Publication Status: ppublish
Résumé
OBJECTIVE: To evaluate, regardless of the clinical results, the contribution of combining functional magnetic resonance imaging (fMRI) with intraoperative cortical brain mapping (iCM) as functional targeting methods for epidural chronic motor cortex stimulation (MCS) in refractory neuropathic pain.
METHODS: Eighteen neuropathic pain patients (central stroke in six; trigeminal neuropathy in six; syrinx or amputation in six) who underwent operations for epidural MCS were studied with preoperative fMRI and iCM. fMRI investigated motor tasks of hands (as well as foot and tongue, when painful). fMRI data were analyzed with Statistical Parametric Mapping99 software (University College London, London, England; initial analysis threshold corresponding to P < 0.001), registered in a neuronavigation system, and correlated during surgery with iCM. The primary aim of this study was to improve the topographical precision of MCS. Matching of fMRI and iCM specifically was examined.
RESULTS: Correspondence between the contour of the fMRI activation area and iCM in precentral gyrus (mean distance, 3.8 mm) was found in 17 (94%) of 18 patients. Eleven of them showed correspondence for more restrictive values of the analysis threshold (P < 0.0001); in six patients, the quality of the iCM was reduced by somatosensory wave attenuation and general anesthesia. In this group of six patients, a combination of both techniques was used for the final targeting. Correspondence was not found in one patient as the result of image distortion and residual motion artifact. At follow-up (4-60 mo), MCS induced significant pain relief in a total of 11 patients (61%).
CONCLUSION: This study confirms the functional accuracy of fMRI guidance in neuropathic pain and illustrates the usefulness of combining fMRI guidance with iCM to improve the functional targeting in MCS. Because appropriate targeting is crucial to obtaining pain relief, this combination may increase the analgesic efficacy of MCS.
Mots-clé
Adult, Aged, Brain Mapping, Electric Stimulation Therapy/adverse effects, Female, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Monitoring, Intraoperative, Motor Cortex/physiopathology, Neuralgia/physiopathology, Neuralgia/therapy, Neuronavigation, Palliative Care, Retrospective Studies, Treatment Outcome
Pubmed
Création de la notice
20/01/2008 17:36
Dernière modification de la notice
20/08/2019 12:25
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