Computerized tomography-quided stereotaxic implantation of deep brainstimulating electrodes

High-resolution computerized tomography (CT) images can detect deep brain commissures, internal capsules and pathological lesions. The intercommissural plane can be determined by a reconstructed sagittal CT image of deep midline structures. The individual CT atlas of the brain of a patient permits precise target identification, and eliminates the need for contrast ventriculography. Three patients, who underwent successful CT-guided stereotaxic implantation of deep brainstimulating electrodes using a Brown-Roberts-Wells apparatus for the control of chronic pain, are reported. The target of two patients who had intractable pain caused by cancer was the thalamic relay nucleus. As the stimulation was effective in controlling the pain, the amounts of analgesics could be reduced. The target of one patient who had thalamic pain was the internal capsule and the pain relief has been excellent. Intraoperative electrophysiological assessments were available to confirm the correct target. Stereotaxic implantation of deep brain electrodes may be the best indication of CT-guided functional neurosurgery. Since this method is easy and accurate, its application to poor risk patient is feasible. (author)