Characterisation of Dentatorubrothalamic tract with Diffusion Spectrum Imaging in Patients suffering from Parkinson’s disease

Abstract Introduction: Clinical data support that the dentatorubrothalamic tract (DRTT) is an effective target for deep brain stimulation (DBS) in medically refractory tremor. Nevertheless, the achievement of a realistically detailed depiction of DRTT for preoperative direct targeting remains a challenge.Methods: Ten patients with Parkinson’s disease from the Inselspital Bern database were selected. We used diffusion spectrum imaging (DSI) scans for deterministic fiber tracking of the DRTT with the Track Vis software. Thereafter we compared our DSI-characterized DRTT with the existing anatomical data.Results: In 6 out of 10 individuals the full course of DRTT has been in high affiliation/consistency/association/adherence with the anatomical course of DRTT as described in literature.Conclusions: In this study DSI fiber tracking was used to characterize successfully the DRTT anatomical course in its complexity in a quest of the optimal DBS target for parkinsonian tremor. To our knowledge such attempt has not occurred before. Further studies are required to standardize the protocol of DRTT fiber Tracking and to implement it as a valid DBS preoperative planning technique.

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Utilization of Quantitative Susceptibility Mapping for Direct Targeting of the Subthalamic Nucleus During Deep Brain Stimulation Surgery

Operative Neurosurgery ◽

10.1093/ons/opx131 ◽

2017 ◽

Vol 14 (4) ◽

pp. 412-419 ◽

Cited By ~ 14

Author(s):

Jonathan Rasouli ◽

Ritesh Ramdhani ◽

Fedor E Panov ◽

Alexey Dimov ◽

Yan Zhang ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Deep Brain Stimulation ◽

Clinical Response ◽

Subthalamic Nucleus ◽

Brain Stimulation ◽

Quantitative Susceptibility Mapping ◽

Direct Targeting ◽

Satisfactory Clinical Response ◽

Deep Brain

AbstractBACKGROUNDDeep brain stimulation of the subthalamic nucleus (STN) has demonstrated efficacy in improving motor disability in Parkinson's disease. The recently developed quantitative susceptibility mapping (QSM) technique, which can accurately map iron deposits in deep brain nuclei, promises precise targeting of the STN.OBJECTIVETo demonstrate the use of QSM to target STN effectively by correlating with classical physiological-based targeting measures in a prospective study.METHODSThe precision and accuracy of direct targeting with QSM was examined in a total of 25 Parkinson's disease patients between 2013 and 2015 at our institution. QSM was utilized as the primary magnetic resonance imaging (MRI) method to perform direct STN targeting on a stereotactic planning station utilizing computed tomography/MR fusion. Intraoperative microelectrode recordings (MER) were obtained to confirm appropriate trajectory through the sensorimotor STN.RESULTSEstimations of STN thickness between the MER and QSM methods appeared to be correlated. Mean STN thickness was 5.3 mm. Kinesthetic responsive cells were found in > 90% of electrode runs. The mean radial error (±SEM) was 0.54 ± 0.1 mm. Satisfactory clinical response as determined by Unified Parkinson's Disease Rating Scale (UPDRS III) was seen at 12 mo after surgery.CONCLUSIONDirect targeting of the sensorimotor STN using QSM demonstrates MER correlation and can be safely used for deep brain stimulation lead placement with satisfactory clinical response. These results imply that targeting based on QSM signaling alone is sufficient to obtain reliable and reproducible outcomes in the absence of physiological recordings.

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The Accuracy of Direct Targeting Using Fusion of MR and CT Imaging for Deep Brain Stimulation of the Subthalamic Nucleus in Patients with Parkinson's Disease

Journal of Neurological Surgery Part A Central European Neurosurgery ◽

10.1055/s-0040-1715826 ◽

2021 ◽

Author(s):

Fadi Almahariq ◽

Goran Sedmak ◽

Vladimira Vuletić ◽

Domagoj Dlaka ◽

Darko Orešković ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Deep Brain Stimulation ◽

Side Effects ◽

Subthalamic Nucleus ◽

Brain Stimulation ◽

Final Position ◽

Emotional Instability ◽

Direct Targeting ◽

Deep Brain

Abstract Introduction In 33 consecutive patients with Parkinson's disease (PD) undergoing awake deep brain stimulation (DBS) without microelectrode recording (MER), we assessed and validated the precision and accuracy of direct targeting of the subthalamic nucleus (STN) using preoperative magnetic resonance imaging (MRI) and stereotactic computed tomography (CT) image fusion combined with immediate postoperative stereotactic CT and postoperative MRI, and we report on the side effects and clinical results up to 6 months' follow-up. Materials and Methods Preoperative nonstereotactic MRI and stereotactic CT images were merged and used for planning the trajectory and final lead position. Immediate postoperative stereotactic CT and postoperative nonstereotactic MRI provided the validation of the final electrode position. Changes in the Unified Parkinson's Disease Rating Scale III (UPDRS III) scores and the levodopa equivalent daily doses (LEDD) and appearance of adverse side effects were assessed. Results The mean Euclidian distance (ED) error between the planned position and the final position of the lead in the left STN was 1.69 ± 0.82 mm and that in the right STN was 2.12 ± 1.00. The individual differences between planned and final position in each of the three coordinates were less than 2 mm. The UPDRS III scores improved by 75% and LEDD decreased by 45%. Few patients experienced complications, such as postoperative infection (n = 1), or unwanted side effects, such as emotional instability (n = 1). Conclusion Our results confirm that direct targeting of an STN on stereotactic CT merged with MRI could be a valid method for placement the DBS electrode. The magnitude of our targeting error is comparable with the reported errors when using MER and other direct targeting approaches.

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Deep Brain Stimulation in Sub-Thalamic Nucleus in idiopathic Parkinson’s disease – our initial experience in four cases

Bangladesh Journal of Neurosurgery ◽

10.3329/bjns.v9i1.42931 ◽

2019 ◽

Vol 9 (1) ◽

pp. 78-83

Author(s):

Md Zahid Raihan ◽

Tipu Zahed Aziz

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Deep Brain Stimulation ◽

Brain Stimulation ◽

Thalamic Nucleus ◽

Idiopathic Parkinson’S Disease ◽

Parkinsonian Tremor ◽

Resting Tremor ◽

Idiopathic Parkinson's Disease ◽

Deep Brain

Parkinson’s Disease ( PD ) is a chronic neurodegenerative disease . It’s cardinal features are resting tremor, Rigidity, Akinesia and postural instability. Idiopathic Parkinson’s disease develops mainly due to degeneration of Dopaminergic neurons of Substantia Nigra. The role of Subthalamic Nucleus ( STN ) in the development of Parkinsonian Tremmor and other cardinal features is not completely understood yet. However previous studies in monkeys , administration of MPTP ( 1-methyl-4-phenyl- 1.2.3.6.-tetrahydropyridine ) proved that sub thalamic nucleus has a direct role in the development of Parkinsonian tremor and other features. We used no Micro Electrode Recording (MER) system,only studied clinically that Parkinsonian tremor stopped immediately after placement of electrode and same thing happened after micro stimulation of the sensorymotor region of the sub thalamic nucleus .Then high frequency deep brain stimulation ( DBS ) of these same four patients were assessed six months after surgery which led to a significant reduction of Parkinsonian tremor as well as other cardinal features of PD ( p< 0.001 ) . Both postural and resting tremor disappeared completely in three cases and significantly reduced in one case Bang. J Neurosurgery 2019; 9(1): 78-83

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