Registro cerebral profundo y tiempo quirúrgico en la neurocirugía estereotáctica funcional para trastornos del movimiento / Deep brain recording and length of surgery in stereotactic and functional neurosurgery for movement disorders

OBJETIVO: Estudiar la duración de los registros cerebrales multiunitarios (RCM) en 20 años de neurocirugías en trastornos del movimiento, así como las veces en que fue necesario explorar todos los trayectos de los electrodos en las posiciones registradas simultáneamente (PRS) por grupos que usan registros cerebrales unitarios (RCU). MATERIAL Y MÉTODO: Análisis estadístico descriptivo retrospectivo de la duración de los RCM en 4.296 trayectos en 952 cirugías. Los criterios de exclusión fueron: trayectos con menos de 5 señales grabadas, o con señales con duración diferente de los 2 s habituales, o cuando existieron situaciones no usuales, ni relacionadas con los RCM, así como las primeras 20 cirugías de cada blanco quirúrgico, resultando así un total de 3.448 trayectos en 805 cirugías. Del total de 952 cirugías, se analiza además en cuántas de ellas fueron explorados todos los trayectos en las PRS de RCU. RESULTADOS: La media y su intervalo de confianza (p = 0,05) del tiempo por trayecto de RCM es 5,49 ± 0,16 min en cirugía en núcleo subtalámico; 8,82 ± 0,24 min en globo pálido medial o interno; y 18,51 ± 1,31 min en núcleo ventral intermedio del tálamo. Para la suma total de trayectos por cirugía, en el 75% de los casos el tiempo total es de menos de 39 min en núcleo subtalámico, casi 42 min en globo pálido medial o interno y menos de 1h y 17 min en núcleo ventral intermedio del tálamo. En solo el 4,2% de las cirugías fueron explorados todos los trayectos en las PRS de RCU. CONCLUSIONES: El impacto de los RCM en el tiempo quirúrgico es aceptable para esta guía en la localización objetiva de los blancos quirúrgicos, sin tener que usar varios electrodos simultáneos, no todos imprescindibles en la mayoría de los casos, con menor riesgo así para el paciente

OBJECTIVE: Our objectives were to study the length of multi-unit recordings (MURs) of brain activity in 20 years of movement disorder neurosurgeries and to determine the number of times in which it was necessary for the teams using single-unit recording (SUR) to explore all the electrode tracks in the simultaneously recorded sites (SRS). MATERIAL AND METHOD: This was a retrospective descriptive statistical analysis of MUR lengthon 4,296 tracks in 952 surgeries. The exclusion criteria were: tracks with fewer than 5 recorded signals, tracks that had a signal length different from the habitual 2 s, or there being unusual situations not related to the MUR, as well as the first 20 surgeries of each surgical target. This yielded a total of 3,448 tracks in 805 surgeries. We also determined the number of the total 952 surgeries in which all the tracks in the SURs of the SRS were explored. RESULTS: The mean and its confidence interval (P = .05) of time per MUR track were5.49 ± 0.16 min in subthalamic nucleus surgery, 8.82 ± 0.24 min in the medial or internalglobus pallidus) and 18.51 ± 1.31min in the ventral intermediate nucleus of the thalamus. For the total sum of tracks per surgery, in 75% of cases the total time was less than 39 min insubthalamic nucleus, almost 42 min in the medial or internal globus pallidus and less than1 h and 17min in ventral intermediate nucleus of the thalamus. All the tracks in the SURSRS were explored in only 4.2% of the surgeries. CONCLUSIONS: The impact of MUR on surgical time is acceptable for this guide in objective

[Deep brain recording and length of surgery in stereotactic and functional neurosurgery for movement disorders]. / Registro cerebral profundo y tiempo quirúrgico en la neurocirugía estereotáctica funcional para trastornos del movimiento.

OBJECTIVE: Our objectives were to study the length of multi-unit recordings (MURs) of brain activity in 20 years of movement disorder neurosurgeries and to determine the number of times in which it was necessary for the teams using single-unit recording (SUR) to explore all the electrode tracks in the simultaneously recorded sites (SRS). MATERIAL AND METHOD: This was a retrospective descriptive statistical analysis of MUR length on 4,296 tracks in 952 surgeries. The exclusion criteria were: tracks with fewer than 5 recorded signals, tracks that had a signal length different from the habitual 2s, or there being unusual situations not related to the MUR, as well as the first 20 surgeries of each surgical target. This yielded a total of 3,448 tracks in 805 surgeries. We also determined the number of the total 952 surgeries in which all the tracks in the SURs of the SRS were explored. RESULTS: The mean and its confidence interval (P=.05) of time per MUR track were 5.49±0.16min in subthalamic nucleus surgery, 8.82±0.24min in the medial or internal globus pallidus) and 18.51±1.31min in the ventral intermediate nucleus of the thalamus. For the total sum of tracks per surgery, in 75% of cases the total time was less than 39min in subthalamic nucleus, almost 42min in the medial or internal globus pallidus and less than 1h and 17min in ventral intermediate nucleus of the thalamus. All the tracks in the SUR SRS were explored in only 4.2% of the surgeries. CONCLUSIONS: The impact of MUR on surgical time is acceptable for this guide in objective localization for surgical targets, without having to use several simultaneous electrodes (not all indispensable in most of the cases). Consequently, there is less risk for the patient.