Implantation of Fetal Tissue for the Management of Parkinson's Disease

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.

Long-term Evaluation of Bilateral Fetal Nigral Transplantation in Parkinson Disease

“…32 A burr hole was placed at the coronal suture and a putamen-shaped grid array with holes at 5-mm intervals was placed onto the stereotactic frame. 33,34 The transplant needle was then directed to the magnetic resonance imagingdetermined zero point of the putamen. Subsequent needle placements were made by manipulating the grid array on the stereotactic frame to use the same cortical entry point.…”

Survival and functional recovery of transplanted human dopaminergic neurons into hemiparkinsonian rats depend on the cannula size of the implantation instrument

“…It is not known, if the survival of human embryonic dopaminergic neurons also depends on the transplantation cannula used. So far, intrastriatal implantation of human embryonic cells has been performed using either cannula technique (Brundin et al, 2000;Lindvall and Bjorklund, 1989) or microinjection pumps (Mendez et al, 2000) or a revolver technique (Breeze et al, 1995).…”

“…Cannula techniques with different diameters varying from 1.5 mm to 0.64 mm have been used in humans (Breeze et al, 1995;Freed et al, 2001), but no study has systematically investigated the correlation between cannula-diameter and transplant survival. It has been shown recently that the usage of a glass capillary for transplantation of dopaminergic cell suspensions significantly increases the graft survival and reduces graft variability compared to a metal cannula (Nikkhah et al, unpublished observations).…”

Interventional Magnetic Resonance Imaging-guided Cell Transplantation Into the Brain With Radially Branched Deployment

“…8,[12][13][14][15][16] While effective for the relatively small brain targets of animal experimental models, straight cannulas can be problematic when used at the scale and complexity of the human brain. 3 For instance, a common approach to translational scaleup involves increasing the number of brain penetrations, 8,[12][13][14][15][16] and each independent cannula insertion injures normal brain tissue and may result in complications such as hemorrhagic stroke.…”

“…8,[12][13][14][15][16] While effective for the relatively small brain targets of animal experimental models, straight cannulas can be problematic when used at the scale and complexity of the human brain. 3 For instance, a common approach to translational scaleup involves increasing the number of brain penetrations, 8,[12][13][14][15][16] and each independent cannula insertion injures normal brain tissue and may result in complications such as hemorrhagic stroke. [17][18][19] While convection enhanced delivery can greatly increase the dispersal of gene therapy vectors and drugs administered through a straight cannula, [20][21][22] this procedure does not increase the distribution of cells, as they are too large to be "pushed" through the interstitial spaces of brain parenchyma.…”