Deep brain stimulation in a pediatric dystonia patient with cochlear implants and mitochondrial disorder: novel application of a frameless stereotactic system and navigating the anesthesia choice and neurosurgical complexities. Illustrative case.

Autor:	Grossen A; Departments of1Neurosurgery and.; 2Department of Neurosurgery, Section of Pediatric Neurosurgery, Oklahoma Children's Hospital, Oklahoma City, Oklahoma., Shi HH; Departments of1Neurosurgery and.; 2Department of Neurosurgery, Section of Pediatric Neurosurgery, Oklahoma Children's Hospital, Oklahoma City, Oklahoma., Schenk M; 3Anesthesiology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma., Stocco A; 4Department of Neurology, Section of Pediatric Neurology, Integris Health, Oklahoma City, Oklahoma., Ramsey J; Departments of5Pediatric Rehabilitation and., Sahgal S; 6Adolescent and Child Psychiatry, Bethany Children's Health Center, Bethany, Oklahoma., Conner AK; Departments of1Neurosurgery and., Desai VR; Departments of1Neurosurgery and.; 2Department of Neurosurgery, Section of Pediatric Neurosurgery, Oklahoma Children's Hospital, Oklahoma City, Oklahoma.
Jazyk:	angličtina
Zdroj:	Journal of neurosurgery. Case lessons [J Neurosurg Case Lessons] 2023 Aug 07; Vol. 6 (6). Date of Electronic Publication: 2023 Aug 07 (Print Publication: 2023).
DOI:	10.3171/CASE23128
Abstrakt:	Background: This report presents a case of medically refractory dystonia in a pediatric patient successfully treated with bilateral subthalamic nucleus (STN) deep brain stimulation (DBS) while under general anesthesia by using microelectrode recordings (MERs) with intraoperative computed tomography (CT). Observations: The patient was an 18-year-old female with primary dystonia secondary to mitochondrial Leigh syndrome. Her past medical history was significant for complex partial epilepsy and hearing loss treated with cochlear implants. Her cochlear implants precluded anatomical targeting via magnetic resonance imaging. Additionally, the patient could not tolerate awake surgery with MER. The decision was made to proceed with bilateral STN DBS with intraoperative CT with the patient under general anesthesia. The patient's cochlear implants made standard frame placement difficult, so navigation was performed with the Nexframe system. Recordings were obtained with the patient under general anesthesia with ketamine, dexmedetomidine, and remifentanil. At the 3- and 6-month follow-ups, the patient demonstrated marked improvement in dystonia without neurological complications. Lessons: This is the first case of dystonia secondary to Leigh syndrome treated with DBS. Additionally, the authors describe the novel use of the Nexframe for DBS lead placement in a pediatric patient. This demonstrates that STN DBS with the use of MER and intraoperative CT can be a safe and effective method of treating dystonia in certain pediatric patients.
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu