Data Fusion and Fuzzy Spatial Relationships for Locating Deep Brain Stimulation Targets in Magnetic Resonance Images

When performing deep brain stimulation (DBS) of the subthalamic nucleus, practitioners should interpret the magnetic resonance images (MRI) correctly so they can place the DBS electrode accurately at the target without damaging the other structures. The aim of this study is to provide a real color volume model of a cadaver head that would help medical students and practitioners to better understand the sectional anatomy of DBS surgery. Sectioned images of a cadaver head were reconstructed into a real color volume model with a voxel size of 0.5 mm × 0.5 mm × 0.5 mm. According to preoperative MRIs and postoperative computed tomographys (CT) of 31 patients, a virtual DBS electrode was rendered on the volume model of a cadaver. The volume model was sectioned at the classical and oblique planes to produce real color images. In addition, segmented images of a cadaver head were formed into volume models. On the classical and oblique planes, the anatomical structures around the course of the DBS electrode were identified. The entry point, waypoint, target point, and nearby structures where the DBS electrode could be misplaced were also elucidated. The oblique planes could be understood concretely by comparing the volume model of the sectioned images with that of the segmented images. The real color and high resolution of the volume model enabled observations of minute structures even on the oblique planes. The volume models can be downloaded by users to be correlated with other patients’ data for grasping the anatomical orientation.

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Successful Deep Brain Stimulation Surgery With Intraoperative Magnetic Resonance Imaging on a Difficult Neuroacanthocytosis Case

Neurosurgery ◽

10.1227/01.neu.0000429852.45073.73 ◽

2013 ◽

Vol 73 (1) ◽

pp. E184-E188 ◽

Cited By ~ 8

Author(s):

Thien Thien Lim ◽

Hubert H. Fernandez ◽

Scott Cooper ◽

Kathryn Mary K. Wilson ◽

Andre G. Machado

Keyword(s):

Magnetic Resonance Imaging ◽

Deep Brain Stimulation ◽

Magnetic Resonance ◽

General Anesthesia ◽

Brain Stimulation ◽

Resonance Imaging ◽

Imaging Guidance ◽

Intraoperative Magnetic Resonance Imaging ◽

Magnetic Resonance Imaging Guidance ◽

Deep Brain

Abstract BACKGROUND AND IMPORTANCE: Chorea acanthocytosis is a progressive hereditary neurodegenerative disorder characterized by hyperkinetic movements, seizures, and acanthocytosis in the absence of any lipid abnormality. Medical treatment is typically limited and disappointing. CLINICAL PRESENTATION: We report on a 32-year-old patient with chorea acanthocytosis with a failed attempt at awake deep brain stimulation (DBS) surgery due to intraoperative seizures and postoperative intracranial hematoma. He then underwent a second DBS operation, but under general anesthesia and with intraoperative magnetic resonance imaging guidance. Marked improvement in his dystonia, chorea, and overall quality of life was noted 2 and 8 months postoperatively. CONCLUSION: DBS surgery of the bilateral globus pallidus pars interna may be useful in controlling the hyperkinetic movements in neuroacanthocytosis. Because of the high propensity for seizures in this disorder, DBS performed under general anesthesia, with intraoperative magnetic resonance imaging guidance, may allow successful implantation while maintaining accurate target localization.

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Accuracy of Magnetic Resonance Imaging–Directed Frame-Based Stereotaxis

Operative Neurosurgery ◽

10.1227/neu.0b013e3182320bd6 ◽

2011 ◽

Vol 70 (suppl_1) ◽

pp. ons114-ons124 ◽

Cited By ~ 1

Author(s):

Nova B. Thani ◽

Arul Bala ◽

Christopher R. P. Lind

Keyword(s):

Deep Brain Stimulation ◽

Magnetic Resonance ◽

Brain Stimulation ◽

Entry Point ◽

Mean Deviation ◽

Guide Tube ◽

3 Dimensional ◽

The Mean ◽

The Brain ◽

Deep Brain

Abstract BACKGROUND: Accurate placement of a probe to the deep regions of the brain is an important part of neurosurgery. In the modern era, magnetic resonance image (MRI)-based target planning with frame-based stereotaxis is the most common technique. OBJECTIVE: To quantify the inaccuracy in MRI-guided frame-based stereotaxis and to assess the relative contributions of frame movements and MRI distortion. METHODS: The MRI-directed implantable guide-tube technique was used to place carbothane stylettes before implantation of the deep brain stimulation electrodes. The coordinates of target, dural entry point, and other brain landmarks were compared between preoperative and intraoperative MRIs to determine the inaccuracy. RESULTS: The mean 3-dimensional inaccuracy of the stylette at the target was 1.8 mm (95% confidence interval [CI], 1.5-2.1. In deep brain stimulation surgery, the accuracy in the x and y (axial) planes is important; the mean axial inaccuracy was 1.4 mm (95% CI, 1.1-1.8). The maximal mean deviation of the head frame compared with brain over 24.1 ± 1.8 hours was 0.9 mm (95% CI, 0.5-1.1). The mean 3-dimensional inaccuracy of the dural entry point of the stylette was 1.8 mm (95% CI, 1.5-2.1), which is identical to that of the target. CONCLUSION: Stylette positions did deviate from the plan, albeit by 1.4 mm in the axial plane and 1.8 mm in 3-dimensional space. There was no difference between the accuracies at the dura and the target approximately 70 mm deep in the brain, suggesting potential feasibility for accurate planning along the whole trajectory.

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Letter: Deep Brain Stimulation of the Pedunculopontine Nucleus Area in Parkinson Disease: Magnetic Resonance Imaging-Based Anatomoclinical Correlations and Optimal Target

Neurosurgery ◽

10.1093/neuros/nyy516 ◽

2018 ◽

Vol 84 (1) ◽

pp. E103-E105 ◽

Cited By ~ 1

Author(s):

Constantin Tuleasca ◽

Jean Régis ◽

Elena Najdenovska ◽

Tatiana Witjas ◽

Nadine Girard ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Deep Brain Stimulation ◽

Magnetic Resonance ◽

Parkinson Disease ◽

Brain Stimulation ◽

Pedunculopontine Nucleus ◽

Resonance Imaging ◽

Optimal Target ◽

Deep Brain ◽

Stimulation Of

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ISOLATION OF THE BRAIN‐RELATED FACTOR OF THE ERROR BETWEEN INTENDED AND ACHIEVED POSITION OF DEEP BRAIN STIMULATION ELECTRODES IMPLANTED INTO THE SUBTHALAMIC NUCLEUS FOR THE TREATMENT OF PARKINSON'S DISEASE

Operative Neurosurgery ◽

10.1227/01.neu.0000335171.38334.39 ◽

2009 ◽

Vol 64 (suppl_5) ◽

pp. ons374-ons384 ◽

Cited By ~ 2

Author(s):

Slawomir Daniluk ◽

Keith G. Davies ◽

Peter Novak ◽

Thai Vu ◽

Jules M. Nazzaro ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Deep Brain Stimulation ◽

Magnetic Resonance ◽

Subthalamic Nucleus ◽

Brain Stimulation ◽

Related Factor ◽

Technical Error ◽

Resonance Imaging ◽

Computed Tomographic ◽

Deep Brain

Abstract OBJECTIVE Although a few studies have quantified errors in the implantation of deep brain stimulation electrodes into the subthalamic nucleus (STN), a significant trend in error direction has not been reported. We have previously found that an error in axial plane, which is of most concern because it cannot be compensated for during deep brain stimulation programming, had a posteromedial trend. We hypothesized that this trend results from a predominance of a directionally oriented error factor of brain origin. Accordingly, elimination of nonbrain (technical) error factors could augment this trend. Thus, implantation accuracy could be improved by anterolateral compensation during target planning. METHODS Surgical technique was revised to minimize technical error factors. During 22 implantations, targets were selected on axial magnetic resonance imaging scans up to 1.5 mm anterolateral from the STN center. Using fusion of postoperative computed tomographic and preoperative magnetic resonance imaging scans, implantation errors in the axial plane were obtained and compared with distances from the lead to the STN to evaluate the benefit of anterolateral compensation. RESULTS Twenty errors and the mean error had a posteromedial direction. The average distances from the lead to the target and to the STN were 1.7 mm (range, 0.8–3.1 mm) and 1.1 mm (range, 0.1–1.9 mm), respectively. The difference between the 2 distances was significant (paired t test, P < 0.0001). The lower parts of the lead were consistently bent in the posteromedial direction on postoperative scout computed tomographic scans, suggesting that a brain-related factor is responsible for the reported error. CONCLUSION Elimination of the technical factors of error during STN deep brain stimulation implantation can result in a consistent posteromedial error. Implantation accuracy may be improved by compensation for this error in advance.

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