Vaskulární koridor pro implantaci stimulační elektrody do nucleus anterior thalami – experimentální studie

Česká verzia

Authors: D. Hrabovský ¹; M. Joukal ²; M. Baláž ³; J. Kunst ³; J. Chrastina ¹
Authors place of work: Neurochirurgická klinika LF MU a FN U sv. Anny v Brně ¹; Anatomický ústav LF MU, Brno ²; I. neurologická klinika LF MU a FN u sv. Anny v Brně ³
Published in the journal: Cesk Slov Neurol N 2023; 86(2): 140-145
Category: Original Paper
doi: https://doi.org/10.48095/cccsnn2023140

Summary

Aim: Stimulation of the anterior thalamic nucleus (ATN) is considered for patients with refractory epilepsy if there is no other surgical option. The target structure, the ATN, protrudes to the lateral brain ventricle as a thalamic tubercle, bordered by the thalamostriate vein laterally and the choroid plexus with the superior choroidal vein medially. The study aim was to analyze this vascular corridor for electrode implantation considering both surgical safety and possible association with stimulation outcomes. The best results are achieved when the anterior part of the ATN is stimulated. Materials and methods: The thalamic tubercle and its vascular borders were identified in dissection of both brain hemispheres of cadaveric specimens with intracranial vessel injections. The width of the vascular corridor was measured at distances of 2, 4, and 6 mm from the covering spot of the thalamostriate vein and choroid plexus or from the junction of these veins. Results: Six cadaveric specimens were measured. The median widths of the vascular corridor were 2.5–3 mm at the 2 mm, and 4–4.5 mm at the 4 mm, and 6 mm measures from the junction points, respectively. A small inconstant venous structure was observed in the dorsal part of the thalamic tubercle. After subtracting 1.3 mm (the diameter of a stimulation electrode) from the corridor width, the reserve space was 1.2–1.8 mm at the distance of 2 mm, and 2.7–3.2 mm at distances of 4 mm, and 6 mm from the junction, respectively. Conclusions: The narrow vascular corridor for electrode implantation (particularly in the anterior part of the thalamic tubercle) requires meticulous presurgical planning and precise implantation to maximize the effect of stimulation treatment while avoiding the risk of vascular conflict.

Keywords:

deep brain stimulation – Epilepsy – stereotaxic techniques – anterior thalamic nucleus – thalamostriate vein

Zdroje

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