Fetal-tissue implants appear to offer long-term clinical benefit to some patients with advanced Parkinson's disease.

No abstract

A relatively simple method for implanting fetal tissue within the human basal ganglia is described. Stereotactic techniques are used to deposit 14 to 16 strands of fetal mesencephalic tissue in a linear array within the putamen bilaterally. To eliminate the need for targeting each needle pass independently, we have devised a novel rotating template/micromanipulator apparatus that can be mounted on a Cosman-Roberts-Wells stereotactic frame. The template contains two parallel columns of nine holes, all spaced at 4-mm intervals. It can be aligned to the longitudinal axis of the putamen and targeted with coordinates for the center point of the putamen. Surgery is performed on an awake patient. Short-term morbidity (4-6 wk) in the form of variability of Parkinsonian signs, particularly "off" symptoms and mild confusion, appears to be the rule with simultaneous bilateral implants.

Forty computed tomography (CT)-assisted aspirations performed with only hand guidance were prospectively compared with 40 performed with a CT body-stereotaxic system. Although there was no statistically significant difference in lesion size and path length between the two groups, use of stereotaxis compared with hand guidance decreased by 75% the number of needle manipulations required to place a needle within a lesion. With the stereotaxic method, only 43 needle manipulations were required to confirm a needle placement in 40 lesions, with no lesion requiring more than two attempts. Use of stereotaxis decreased the number of localization scans by 80% and biopsy time by 50%. It is concluded that CT-guided needle placements with hand guidance are often inaccurate and, unless the lesion is large, require multiple needle manipulations to place a needle within the lesion. Stereotaxis-guided biopsies, on the other hand, decrease radiation exposure, biopsy time, and trauma from multiple needle punctures.

No abstract