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Rubrospinal activation during asleep subthalamic nucleus deep brain stimulation: a false localizing sign. Illustrative case
BACKGROUND: Deep brain stimulation (DBS) can be a life-changing intervention for patients with Parkinson’s disease (PD), but its success is largely dependent on precise lead placement. The subthalamic nucleus (STN) is one of the most common surgical targets of DBS, but the close anatomical and physi...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
American Association of Neurological Surgeons
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10555643/ https://www.ncbi.nlm.nih.gov/pubmed/37458360 http://dx.doi.org/10.3171/CASE23100 |
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author | Mitchell, Devon L. Pearce, John King, Patrick Sani, Sepehr |
author_facet | Mitchell, Devon L. Pearce, John King, Patrick Sani, Sepehr |
author_sort | Mitchell, Devon L. |
collection | PubMed |
description | BACKGROUND: Deep brain stimulation (DBS) can be a life-changing intervention for patients with Parkinson’s disease (PD), but its success is largely dependent on precise lead placement. The subthalamic nucleus (STN) is one of the most common surgical targets of DBS, but the close anatomical and physiological resemblance of the STN to the mediocaudal red nucleus renders these landmarks difficult to distinguish. OBSERVATIONS: We present an atypical case in which targeted localization of the STN resulted in symptoms pathognomonic of rubrospinal tract (RST) stimulation. A 79-year-old female with a 12-year history of right-hand resting tremor due to medically refractory PD presented for asleep bilateral STN-DBS surgery. Right STN intraoperative testing revealed left hand and elbow flexion contractures, initially suggestive of corticospinal tract activation, despite imaging studies demonstrating reasonable lead placement in the central dorsolateral STN. The lead was moved anteromedially near the medial border of the STN, but stimulation at this location revealed similar but more robust flexor hand and arm contractures, without any extraocular muscle involvement. Thus, activation of the RST was suspected. LESSONS: Isolated activation of the RST is possible during STN-DBS surgery. Its identification can help avoid false localization and suboptimal lead placement. |
format | Online Article Text |
id | pubmed-10555643 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | American Association of Neurological Surgeons |
record_format | MEDLINE/PubMed |
spelling | pubmed-105556432023-10-07 Rubrospinal activation during asleep subthalamic nucleus deep brain stimulation: a false localizing sign. Illustrative case Mitchell, Devon L. Pearce, John King, Patrick Sani, Sepehr J Neurosurg Case Lessons Case Lesson BACKGROUND: Deep brain stimulation (DBS) can be a life-changing intervention for patients with Parkinson’s disease (PD), but its success is largely dependent on precise lead placement. The subthalamic nucleus (STN) is one of the most common surgical targets of DBS, but the close anatomical and physiological resemblance of the STN to the mediocaudal red nucleus renders these landmarks difficult to distinguish. OBSERVATIONS: We present an atypical case in which targeted localization of the STN resulted in symptoms pathognomonic of rubrospinal tract (RST) stimulation. A 79-year-old female with a 12-year history of right-hand resting tremor due to medically refractory PD presented for asleep bilateral STN-DBS surgery. Right STN intraoperative testing revealed left hand and elbow flexion contractures, initially suggestive of corticospinal tract activation, despite imaging studies demonstrating reasonable lead placement in the central dorsolateral STN. The lead was moved anteromedially near the medial border of the STN, but stimulation at this location revealed similar but more robust flexor hand and arm contractures, without any extraocular muscle involvement. Thus, activation of the RST was suspected. LESSONS: Isolated activation of the RST is possible during STN-DBS surgery. Its identification can help avoid false localization and suboptimal lead placement. American Association of Neurological Surgeons 2023-07-10 /pmc/articles/PMC10555643/ /pubmed/37458360 http://dx.doi.org/10.3171/CASE23100 Text en © 2023 The authors https://creativecommons.org/licenses/by-nc-nd/4.0/CC BY-NC-ND 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) ) |
spellingShingle | Case Lesson Mitchell, Devon L. Pearce, John King, Patrick Sani, Sepehr Rubrospinal activation during asleep subthalamic nucleus deep brain stimulation: a false localizing sign. Illustrative case |
title | Rubrospinal activation during asleep subthalamic nucleus deep brain stimulation: a false localizing sign. Illustrative case |
title_full | Rubrospinal activation during asleep subthalamic nucleus deep brain stimulation: a false localizing sign. Illustrative case |
title_fullStr | Rubrospinal activation during asleep subthalamic nucleus deep brain stimulation: a false localizing sign. Illustrative case |
title_full_unstemmed | Rubrospinal activation during asleep subthalamic nucleus deep brain stimulation: a false localizing sign. Illustrative case |
title_short | Rubrospinal activation during asleep subthalamic nucleus deep brain stimulation: a false localizing sign. Illustrative case |
title_sort | rubrospinal activation during asleep subthalamic nucleus deep brain stimulation: a false localizing sign. illustrative case |
topic | Case Lesson |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10555643/ https://www.ncbi.nlm.nih.gov/pubmed/37458360 http://dx.doi.org/10.3171/CASE23100 |
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