Neuropsychological outcomes after subthalamic nucleus deep brain stimulation

Introduction: Deep brain stimulation of the zona incerta is effective at treating tremor and other forms of parkinsonism. However, the structure is not well visualized with standard MRI protocols making direct surgical targeting unfeasible and contributing to inconsistent clinical outcomes. In this study, we applied coronal gradient echo MRI to directly visualize the rostral zona incerta in Parkinson’s disease patients to improve targeting for deep brain stimulation. Methods: We conducted a prospective study to optimize and evaluate an MRI sequence to visualize the rostral zona incerta in patients with Parkinson’s disease (n = 31) and other movement disorders (n = 13). We performed a contrast-to-noise ratio analysis of specific regions of interest to quantitatively assess visual discrimination of relevant deep brain structures in the optimized MRI sequence. Regions of interest were independently assessed by 2 neuroradiologists, and interrater reliability was assessed. Results: Rostral zona incerta and subthalamic nucleus were well delineated in our 5.5-min MRI sequence, indicated by excellent interrater agreement between neuroradiologists for region-of-interest measurements (>0.90 intraclass coefficient). Mean contrast-to-noise ratio was high for both rostral zona incerta (6.39 ± 3.37) and subthalamic nucleus (17.27 ± 5.61) relative to adjacent white matter. There was no significant difference between mean signal intensities or contrast-to-noise ratio for Parkinson’s and non-Parkinson’s patients for either structure. Discussion/Conclusion: Our optimized coronal gradient echo MRI sequence delineates subcortical structures relevant to traditional and novel deep brain stimulation targets, including the zona incerta, with high contrast-to-noise. Future studies will prospectively apply this sequence to surgical planning and postimplantation outcomes.

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Real Color Model of a Cadaver for Deep Brain Stimulation of the Subthalamic Nucleus

Applied Sciences ◽

10.3390/app11114999 ◽

2021 ◽

Vol 11 (11) ◽

pp. 4999

Author(s):

Chung-Yoh Kim ◽

Jin-Seo Park ◽

Beom-Sun Chung

Keyword(s):

Deep Brain Stimulation ◽

Subthalamic Nucleus ◽

Brain Stimulation ◽

Magnetic Resonance Images ◽

Target Point ◽

Anatomical Structures ◽

Volume Model ◽

Segmented Images ◽

Volume Models ◽

Deep Brain

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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