RESUMEN
BACKGROUND/AIMS: Stereotactic postoperative imaging is essential for verification of the position of electrodes implanted for deep brain stimulation (DBS). MRI offers superior visualisation of the DBS targets relative to CT, but previous adverse incidents have heightened concerns about risks of postoperative MRI. Preoperative MRI fused with postoperative CT offers an alternative method for evaluating electrode position, but before this method can be clinically applied, the image registration accuracy must be established. The purpose of this study was to quantitatively assess the accuracy of three different image registration and fusion methods. METHODS: Preoperative stereotactic MRI and postoperative stereotactic CT were acquired from 20 patients under- going DBS surgery (35 electrodes in total). The postoperative CT was registered and fused with the preoperative MRI, using three different registration algorithms. The position of each electrode tip was determined in stereotactic coordinates both in the (unfused) postoperative CT and the fused CT/MRI. The difference in tip position between the CT and fused CT/MRI was used to evaluate the registration accuracy. RESULTS: The mean error along the lateral, anteroposterior, and vertical axes was 0.5, 0.5, and 1 mm, respectively. CONCLUSIONS: CT/MRI fusion provides a safe, practical technique for postoperative identification of DBS electrodes.
Asunto(s)
Mapeo Encefálico/métodos , Estimulación Encefálica Profunda , Imagen por Resonancia Magnética/métodos , Imagen por Resonancia Magnética/normas , Tomografía Computarizada por Rayos X/métodos , Tomografía Computarizada por Rayos X/normas , Adolescente , Adulto , Anciano , Algoritmos , Electrodos Implantados , Femenino , Humanos , Masculino , Persona de Mediana Edad , Periodo Posoperatorio , Sistema de Registros , Reproducibilidad de los Resultados , Técnicas Estereotáxicas , Núcleo Subtalámico/anatomía & histología , Núcleo Subtalámico/diagnóstico por imagenAsunto(s)
Llanto/psicología , Estimulación Encefálica Profunda/efectos adversos , Núcleo Subtalámico/fisiología , Estimulación Encefálica Profunda/métodos , Progresión de la Enfermedad , Femenino , Humanos , Persona de Mediana Edad , Enfermedad de Parkinson/complicaciones , Enfermedad de Parkinson/psicología , Enfermedad de Parkinson/terapiaAsunto(s)
ADN Polimerasa Dirigida por ADN/genética , Distonía , Epilepsia , Mitocondrias/patología , Mutación/genética , Ataxias Espinocerebelosas , Encéfalo/patología , ADN Polimerasa gamma , Distonía/complicaciones , Distonía/genética , Distonía/patología , Epilepsia/complicaciones , Epilepsia/genética , Epilepsia/patología , Femenino , Humanos , Estudios Longitudinales , Imagen por Resonancia Magnética , Ataxias Espinocerebelosas/complicaciones , Ataxias Espinocerebelosas/genética , Ataxias Espinocerebelosas/patología , Adulto JovenAsunto(s)
Encefalopatías , COVID-19 , Glioma , Síndrome de Opsoclonía-Mioclonía , Glioma/complicaciones , Humanos , Leucina , SARS-CoV-2RESUMEN
Modernising Medical Careers will be introduced from August 2005 and will significantly change the system of education and training for doctors in the UK. The impact of these changes on NHS service delivery needs to be fully understood and is discussed in this article.
Asunto(s)
Selección de Profesión , Educación de Postgrado en Medicina/organización & administración , Costos y Análisis de Costo , Atención a la Salud/normas , Educación de Postgrado en Medicina/economía , Fundaciones , Humanos , Medicina Estatal/normas , Reino UnidoAsunto(s)
Estimulación Encefálica Profunda , Infecciones por VIH/complicaciones , Enfermedad de Parkinson/complicaciones , Enfermedad de Parkinson/terapia , Fármacos Anti-VIH/uso terapéutico , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Enfermedad de Parkinson/patología , Núcleo Subtalámico/fisiología , Resultado del TratamientoRESUMEN
The beneficial effects of deep brain stimulation (DBS) of the subthalamic nucleus (STN) for the motor symptoms in advanced Parkinson's disease (PD) are well established. Early in PD, mild cognitive impairment is present in a proportion of patients. Hence, it can also be present in PD patients considered for DBS. The potential impact of even a modest decline post-surgically is a concern because it could result in impaired cognitive function. Therefore, attempts to determine which pre-operative cognitive measures predict post-operative cognitive change warrant further attention. We report our findings in a cohort of 30 routinely operated non-demented patients who underwent detailed neuropsychological assessments on average 7.1 months before and 9.4 months after STN DBS. We report the individual and group differences pre- and post-DBS. Stepwise regression analysis was used to analyse the best cognitive predictors of post-operative cognitive changes. We describe our data in relation to published normative data. Post-STN DBS, the immediate story recall component of verbal memory was the most affected cognitive function showing a significant decline in its group mean with a large effect size. The best predictors for this change were pre-surgical list learning and Full Scale Intelligence Quotient. These results suggest that non-demented patients, with even mild impairments in both general intellectual functions and list learning, may be at greater risk of decline in other aspects of verbal memory after STN DBS. Pre-existing mild executive dysfunction was not influenced post-operatively. These findings may help selection and consent for STN DBS.