Neurosurgery notes/Procedures/Cranial procedures/Functional cranial procedures/Cranial stimulation/Stimulation side effects

Stimulation side effects

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Cranial stimulation

General

  • Helps with which tract to explore next
    Frontal section 1.5mm behind MCP
    Frontal section 1.5mm behind MCP
    Sagittal section 12mm lateral to AC-PC
    Sagittal section 12mm lateral to AC-PC
        Illustration of some targets for functional brain surgery. AC: anterior commissure; GPi: globus pallidus interna; H₁: Forel’s H₁ field; MCP: midcommissural point (halfway between AC and PC); PC: posterior commissure; STN: subthalamic nucleus; Subst. nigra: substantia nigra; z.i: zona incerta.
        Illustration of some targets for functional brain surgery. AC: anterior commissure; GPi: globus pallidus interna; H₁: Forel’s H₁ field; MCP: midcommissural point (halfway between AC and PC); PC: posterior commissure; STN: subthalamic nucleus; Subst. nigra: substantia nigra; z.i: zona incerta.
    • General risk of DBS surgery include infection, intracerebral haemorrhage, electrode malposition, and lead-related complications (fractures/infection).
    • Stimulation related side effects related to direction of current spread and adjacent structures are outlined below:
        • Target
        Current Spread
        Site Affected
        Side Effect
        STN
        STN
        STN
        Blepharospasm
        ㅤ
        Anterior
        Corticospinal tract, Hypothalamus
        Tonic contractions, Sweating/flushing
        ㅤ
        Posterior
        Medial lemniscus
        Paresthesias
        ㅤ
        Medial
        Red nucleus
        Ataxia
        ㅤ
        Inferomedial
        CNIII/Supranuclear oculomotor center
        Diplopia
        ㅤ
        Lateral
        Corticobulbar tract
        Dysarthria
        GPi
        Anterior
        Optic tract
        Photopsias
        ㅤ
        Posterior
        Medial lemniscus
        Paresthesias
        ㅤ
        Posteromedial
        Internal capsule
        Tonic contraction
        VIM thalamus
        Target
        VIM thalamus
        Microthalamotomy effect
        ㅤ
        Anterior
        Cerebellothalamic tract
        Ataxia
        ㅤ
        Posterior
        VPL thalamus
        Paresthesia
        ㅤ
        Lateral
        Internal capsule
        Tonic contraction

    Side Effects Around STN

    • Internal capsule
      • Anterior and Lateral
      • Limb/facial contraction
    • Medial lemniscus
      • Posterior — paresthesia
      • Transient tingling can ignore
    • Nerve roots CN Ill
      • Medial —diplopia
    • Red nucleus
      • Medial
        • Ataxia
        • Unpleasant feelings, sweating
    • Substantia nigra
      • Inferior -Sense of doom

    Subthalamic nucleus

    Slightly oblique section of the forebrain through the anterior nucleus of the thalamus and the subthalamic nucleus. The section also includes the rostral portion of the midbrain tegmentum. Many of the structures labeled in this figure can be easily identified in the T1-weighted MRI adjacent to the photograph.
    Slightly oblique section of the forebrain through the anterior nucleus of the thalamus and the subthalamic nucleus. The section also includes the rostral portion of the midbrain tegmentum. Many of the structures labeled in this figure can be easily identified in the T1-weighted MRI adjacent to the photograph.
    Sagittal section through the caudate nucleus, central parts of the diencephalon (ventral posteromedial nucleus), and lateral portions of the pons and cerebellum (dentate nucleus). The heavy line represents the approximate plane of the axial section. Many of the structures labeled in this photograph can be clearly identified in the adjacent T1-weighted MRI.
    Sagittal section through the caudate nucleus, central parts of the diencephalon (ventral posteromedial nucleus), and lateral portions of the pons and cerebellum (dentate nucleus). The heavy line represents the approximate plane of the axial section. Many of the structures labeled in this photograph can be clearly identified in the adjacent T1-weighted MRI.
    Abbreviation
    Structure
    Abbreviation
    Structure
    AC
    Anterior commissure
    MGNu
    Medial geniculate nucleus
    AmyNu
    Amygdaloid nucleus (complex)
    OpTr
    Optic tract
    BrSC
    Brachium of superior colliculus
    PCNu
    Posterior cochlear nucleus
    CaNu
    Caudate nucleus
    PulNu
    Pulvinar nuclear complex
    CC
    Crus cerebri
    Put
    Putamen
    DNu
    Dentate nucleus (lateral cerebellar nucleus)
    SN
    Substantia nigra
    GPL
    Globus pallidus, lateral segment
    SThNu
    Subthalamic nucleus
    GPM
    Globus pallidus, medial segment
    ThFas
    Thalamic fasciculus
    Hip
    Hippocampal formation
    VL
    Ventral lateral nucleus of thalamus
    LenFas
    Lenticular fasciculus
    VPM
    Ventral posteromedial nucleus of thalamus
    MCP
    Middle cerebellar peduncle (brachium pontis)
    ZI
    Zona incerta
    Coronal section of the forebrain through the lateral dorsal nucleus, massa intermedia, and subthalamic nucleus. Many of the structures labeled in this figure can be easily identified in the T1-weighted MRI adjacent to the photograph.
    Coronal section of the forebrain through the lateral dorsal nucleus, massa intermedia, and subthalamic nucleus. Many of the structures labeled in this figure can be easily identified in the T1-weighted MRI adjacent to the photograph.
    Slightly oblique section through the midbrain-diencephalon junction. The section passes through the posterior commissure, the rostral end of the red nucleus, and ends just dorsal to the mammillary body. At this level, the structure labeled mammillothalamic tract probably also contains some mammillotegmental fibers. Structures at the midbrain-thalamus junction are best seen in an MRI angled to accommodate that specific plane. To make the transition from drawing to stained section to MRI easy, selected structures in the MRI are labeled.
    Slightly oblique section through the midbrain-diencephalon junction. The section passes through the posterior commissure, the rostral end of the red nucleus, and ends just dorsal to the mammillary body. At this level, the structure labeled mammillothalamic tract probably also contains some mammillotegmental fibers. Structures at the midbrain-thalamus junction are best seen in an MRI angled to accommodate that specific plane. To make the transition from drawing to stained section to MRI easy, selected structures in the MRI are labeled.
    Slightly oblique section of the forebrain through the pulvinar, ventral posteromedial, and ventral posterolateral nuclei. The section extends rostrally through the subthalamic nucleus and ends in the caudal hypothalamus just dorsal to the mammillary bodies as seen by the position of the (postcommissural) fornix.
    Slightly oblique section of the forebrain through the pulvinar, ventral posteromedial, and ventral posterolateral nuclei. The section extends rostrally through the subthalamic nucleus and ends in the caudal hypothalamus just dorsal to the mammillary bodies as seen by the position of the (postcommissural) fornix.

    GPi

    Axial section through the head of the caudate nucleus, ventral posteromedial nucleus, medial geniculate body, and ventral parts of the pulvinar. The heavy line represents the approximate plane of the sagittal section. Many of the structures labeled in this photograph can be clearly identified in the adjacent T1-weighted MRI.
    Axial section through the head of the caudate nucleus, ventral posteromedial nucleus, medial geniculate body, and ventral parts of the pulvinar. The heavy line represents the approximate plane of the sagittal section. Many of the structures labeled in this photograph can be clearly identified in the adjacent T1-weighted MRI.
    Abbreviation
    Structure
    Abbreviation
    Structure
    AC
    Anterior commissure
    IntCap,AL
    Internal capsule, anterior limb
    ALV
    Atrium of lateral ventricle
    IntCap,Pl
    Internal capsule, posterior limb
    CaNu,H
    Caudate nucleus, head
    IntCap,RL
    Internal capsule, retrolenticular limb
    CeGy
    Central gray (periaqueductal gray)
    LT
    Lamina terminalis
    CI
    Claustrum
    MGNu
    Medial geniculate nucleus
    CM
    Centromedian nucleus of thalamus
    MtTr
    Mammillothalamic tract
    CP
    Choroid plexus
    OpRad
    Optic radiations
    For,Col
    Fornix, column
    PulNu
    Pulvinar nuclear complex
    GPL
    Globus pallidus, lateral segment
    Put
    Putamen
    GPM
    Globus pallidus, medial segment
    SC
    Superior colliculus
    Hip
    Hippocampal formation
    VL
    Ventral lateral nucleus of thalamus
    Hip,F
    Hippocampus, fimbria
    VPL
    Ventral posterolateral nucleus of thalamus
    HyTh
    Hypothalamus
    VPM
    Ventral posteromedial nucleus of thalamus
    Sagittal section through the caudate nucleus, central parts of the diencephalon (ventral posteromedial nucleus), and lateral portions of the pons and cerebellum (dentate nucleus). The heavy line represents the approximate plane of the axial section. Many of the structures labeled in this photograph can be clearly identified in the adjacent T1-weighted MRI.
    Sagittal section through the caudate nucleus, central parts of the diencephalon (ventral posteromedial nucleus), and lateral portions of the pons and cerebellum (dentate nucleus). The heavy line represents the approximate plane of the axial section. Many of the structures labeled in this photograph can be clearly identified in the adjacent T1-weighted MRI.
    Abbreviation
    Structure
    Abbreviation
    Structure
    AC
    Anterior commissure
    MGNu
    Medial geniculate nucleus
    AmyNu
    Amygdaloid nucleus (complex)
    OpTr
    Optic tract
    BrSC
    Brachium of superior colliculus
    PCNu
    Posterior cochlear nucleus
    CaNu
    Caudate nucleus
    PulNu
    Pulvinar nuclear complex
    CC
    Crus cerebri
    Put
    Putamen
    DNu
    Dentate nucleus (lateral cerebellar nucleus)
    SN
    Substantia nigra
    GPL
    Globus pallidus, lateral segment
    SThNu
    Subthalamic nucleus
    GPM
    Globus pallidus, medial segment
    ThFas
    Thalamic fasciculus
    Hip
    Hippocampal formation
    VL
    Ventral lateral nucleus of thalamus
    LenFas
    Lenticular fasciculus
    VPM
    Ventral posteromedial nucleus of thalamus
    MCP
    Middle cerebellar peduncle (brachium pontis)
    ZI
    Zona incerta
    Coronal section of the forebrain through the interventricular foramen, genu of the internal capsule, rostral tip of the dorsal thalamus, and about the middle one-third of the hypothalamus. Many of the structures labeled in this figure can be easily identified in the T1-weighted MRI adjacent to the photograph.
    Coronal section of the forebrain through the interventricular foramen, genu of the internal capsule, rostral tip of the dorsal thalamus, and about the middle one-third of the hypothalamus. Many of the structures labeled in this figure can be easily identified in the T1-weighted MRI adjacent to the photograph.