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DBS > Stage 1 > Flashcards

Stage 1 Flashcards

1
Q

Structures of the Basal Ganglia

A

Striatum (Putamen, Caudate)
Globus Pallidus (GPi, GPe)
STN
SNr

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2
Q

What is the target of cortical input to the Basal Ganglia?

A

Striatum (Caudate, Putamen)

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3
Q

The source of output to the thalamus?

A

Globus Pallidus (GPi, GPe)

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4
Q

Target location for GPi

A

Posteroventral

Sensorimotor portion directly superior to optic tract

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5
Q

Target location for STN

A

Dorsolateral aspect

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6
Q

What exams are used for indirect targeting?

A

T1 MRI

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7
Q

What exams may be used for direct targeting?

A

T2 MRI

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8
Q

Approximate STN coordinates

A

X: 11-15mm (12mm mean) lateral from MCP
Y: 2-3 mm posterior from MCP
Z: 3-4 mm ventral to ACPC line
Arc angle: 15 degrees Ring angle: 60 degrees

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9
Q

Approximate Vim coordinates

A

X: 10.5-11.5 mm + 1/2 width of 3rd ventricle
Y: 25% of the ACPC length posterior to MCP
Z: 0 MCP plane
Arc: 15 degrees Ring: 60 degrees

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10
Q

Approximate GPi coordinates

A

X: 18-23 mm lateral from MCP
Y: 2-3 mm anterior to MCP
Z: 2-4 mm ventral to MCP
Arc: 0-10 degrees Ring: 60 degrees

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11
Q

Thalamic homunculus

A

Medial (face), central (arm tremor), to Lateral (feet)

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12
Q

Ventriculography

A

X-ray

Contrast is injected into the CSF allowing visualization of the ventricles and ACPC

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13
Q

CT Image observations

A

Bone is white, tissue is grey, fluid is dark

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14
Q

Area of interest size for a T2 scan

A

28 to 32 cm

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15
Q

The three guide tube lengths for A/O cannula

A

25mm (most common)
15mm
10mm

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16
Q

Name lead length for A/O drive

Name lead length for Star drive

A 
A/O = 237mm (length of micro electrode)
Star = 375mm
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17
Q

Length of A/O MER tip

A

3mm (most common)

10mm

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18
Q

Length of FHC MER tips

A

10mm most common

3mm

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19
Q

Above target ranges for FHC cannula

A

40mm
20mm
To target

20
Q

The cannula and lead (A/O) and FHC move all together or separately in an array?

A

All together for A/O

FHC array moves together, single does not move

21
Q

Leksell

Right, Posterior, Superior= ?
Left, anterior, inferior = ?

A

Left, anterior, inferior = >100

Right, posterior, superior =

22
Q

Structures to avoid in all procedures

A
  1. Sulci and blood vessels
  2. Ventricles
  3. Optic tract (close proximity, not pierced)
23
Q

Anatomy pierced when targeting STN

A
  1. Cortex (gyrus)
  2. Sub cortical white matter
  3. Caudate (unless more lateral trajectory angle used)
  4. Thalamus (usually VOP)
  5. Zola incerta
  6. STN
  7. Subtanstia nigra
24
Q

Anatomy pierced when targeting VIM

A
  1. Cortex (gyrus)
  2. Us cortical white matter
  3. Caudate (unless a more lateral trajectory used)
  4. Dorsal thalamus
  5. Ventral thalamus: vim nucleus- target
  6. Ventral thalamus: VC nucleus (dbs electrode not placed here but blunt tip could be)
  7. Zona incerta (possibly with tip)
25
Q

Anatomy pierced when targeting GPi

A
  1. Cortex (gyrus)
  2. Sub cortical white matter
  3. Putamen
  4. Globus pallidus externus
  5. Globus pallidus internus (target)
26
Q

What are the imaging protocols for CT and MRI?

A

CT- no gaps contiguous, full field of view - whole head, no gantry tilt, 3mm slices,

MRI - 3mm slices or less, T2 field of view is slab 28-32cm, no oblique slices, contiguous no gaps, square matrix

27
Q

When should gadolinium be used?

A

Run T2, then inject gad run T1 right away, to increase visibility of vascular structures

28
Q

STN bordered by what?

A 
ZI - superior
IC - lateral & anterior
Red nucleus - posteromedial 
Medial lemniscus - posterior
CN 3 - medial / ventralmedial 
Autonomic pathways - very anteromedial
SNr- inferior/ventral
29
Q

CRW distances, center, positive negative directions

A

160 mm distance to top of tool carrier
Coordinates to center = 0/0/0

Superior, anterior, right = positive (+)
Left, inferior, posterior = negative (-)

30
Q

Frames are accurate w/in what margin?

A

2mm

31
Q

Average AC-PC length is

A

22-26, 24 avg

32
Q

FHC microdrive

A

Target is 30mm and top of dbs holder to end of measuring tool is 375MM

33
Q

Leksell frame with A/O drive

A

Tool holder must be set to positive 30mm

34
Q

Lead lengths

A 
3387 = 10.5
3389 = 7.5 
(These are from base of contact 0)
3387 = 12
3389 = 9
(From distal tip of lead to top of contact 3)
35
Q

Examples of gray matter

A

STN, SNR, GPi, thalamus, putamen,

Grey because they’re unmylenated neurons

36
Q

SAR

A

0.1 w kilo

37
Q

MER

Tremor cell
Kinesthetic cell

A

Tremor cell - Synchronized with patients tremor

Kinesthetic cell - You will hear it fire with active or passive firing of the joint

38
Q

If you hit a little thalamus, where could you be?

A

Anterior, Posterior

39
Q

Name examples of white matter

A

Internal capsule
Zona incerta
AC/PC
Optic tract, corpus collusom

White because mylenated nerve cells,

40
Q

Arc/ring typical ranges on the stealth

A

Arc 13.5-24 degrees

Ring 55-65 degrees

41
Q

Default trajectories for ring and arc angle

A

15 arc degrees parasagittal

60 degrees from axial

42
Q

How do I tell I’m holding CRW correctly?

A

Two eyeballs, written on the frame

43
Q

For leksell do what for sterile

A

Avg y and z

44
Q

Here is a scenario, from i.e. Wrong what do you do?

A

You can ID the problem, cannot solve the problem. Surgeon or rep of the manufacturer must solve it

45
Q

Motor thalamus

A

Pallidus receiving = VOP/VOA
Cerebellar = VIM motor
Lemniscal = sensory VC

DBS (1 decks)

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