Nous prsentons la technique dimplantation bilatrale dlectrodes de stimulation du noyau sous-thalamique (NST), base sur des adaptations du cadre strotaxique Fisher ZD et ses rsultats dans la maladie de Parkinson. Aprs fixation du cadre, acquisition strotaxique et fusion des images scanner et IRM, les coordonnes du NST taient calcules par rapport ACPC et par visualisation directe. Pour permettre la vrification peropratoire de la localisation des lectrodes par radiographies orthogonales antropostrieures et latrale, en vitant la projection du bras du cadre sur la zone dintrt, ce bras tait fix 45, ce qui ncessitait la transformation trigonomtrique des coordonnes X et Y. La reconnaissance de marqueurs radio-opaques situs sur quatre plaques fixes au cadre permettait de recalculer les coordonnes de llectrode et visualiser sa position, par projection des coordonnes strotaxiques sur le planning propratoire. Les lectrodes taient implantes sous anesthsie locale, en saidant des enregistrement lectrophysiologiques par microlectrodes et de stimulations tests pour valuer les effets thrapeutiques et secondaires. Aucun problme d aux modifications du cadre nest survenu chez 60 patients oprs. Dans tous les cas, les radiographies peropratoires ont permis de vrifier la localisation des lectrodes. Six mois aprs lintervention, le score UPDRS III sans traitement tait diminu de 52% (stimulateur allum); les items 32, 33 et 39 du score UPDRS IV et les traitements antiparkinsoniens taient diminus respectivement de 75,7, 79,5, 72 et 71%. Les principales complications taient un hmatome thalamique asymptomatique et deux infections du matriel. Cette mthode sest avre efficace et sre pour implanter des lectrodes intracrbrales profondes, sans salle de tlmtrie ddie.

We present the method and results of an original technique to implant electrodes in the subthalamic nucleus (STN) to treat Parkinson's disease, based on adaptations of the Fisher ZD stereotactic frame.

Targets coordinates were calculated after fusion of stereotactic CT-scan and MRI images. STN was localized by its theoretical coordinates according to ACPC and by its direct visualization on T2 images. Electrodes were implanted after local anesthesia, using peroperative multicanal microrecordings and test stimulation. Electrodes location was checked by peroperative perpendicular radiographs. To avoid projection of the frame arm on the area of interest on anteroposterior and lateral radiographs, the arm was fixed at 45 from the usual 90 position. This original fixation needed a trigonometric transformation of the X and Y stereotactic coordinates. Radiopaque markers, fixed on the frame, were identified on the radiographs, allowing the calculation of the stereotactic coordinates of the electrode tip, which were then entered in the stereotactic MRI, to check its location from the defined target.

No problem due to adaptations of the frame occurred in the 60 patients. In all cases, peroperative radiographs allowed to confirm the correct location of electrodes. Six months after surgery, UPDRS III score without medication was decreased by 52% with stimulation on. UPDRS IV items 32, 33 and 39 scores were decreased by 75,7, 79,5 and 72%. Daily dopa-equivalent dose was decreased by 71%. One asymptomatic thalamic hematoma and two wound infections occurred.

This method was efficient and safe to implant deep electrodes.