Is The Future Now? DBS Pallidotomy Thalamotomy on an Outpatient Basis?

[John Cottingham <jcott@xxxxxxxxx>]

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