Automated Optimization of Subcortical Cerebral MR Imaging−Atlas Coregistration for Improved Postoperative Electrode Localization in Deep Brain Stimulation

Object Deep brain stimulation (DBS) is an established neurosurgical technique used to treat a variety of neurological disorders, including Parkinson disease, essential tremor, dystonia, epilepsy, depression, and obsessive-compulsive disorder. This study reports on the use of intraoperative MR imaging during DBS surgery to evaluate acute hemorrhage, intracranial air, brain shift, and accuracy of lead placement. Methods During a 46-month period, 143 patients underwent 152 DBS surgeries including 289 lead placements utilizing intraoperative 1.5-T MR imaging. Imaging was supervised by an MR imaging physicist to maintain the specific absorption rate below the required level of 0.1 W/kg and always included T1 magnetization-prepared rapid gradient echo and T2* gradient echo sequences with selected use of T2 fluid attenuated inversion recovery (FLAIR) and T2 fast spin echo (FSE). Retrospective review of the intraoperative MR imaging examinations was performed to quantify the amount of hemorrhage and the amount of air introduced during the DBS surgery. Results Intraoperative MR imaging revealed 5 subdural hematomas, 3 subarachnoid hemorrhages, and 1 intraparenchymal hemorrhage in 9 of the 143 patients. Only 1 patient experiencing a subarachnoid hemorrhage developed clinically apparent symptoms, which included transient severe headache and mild confusion. Brain shift due to intracranial air was identified in 144 separate instances. Conclusions Intraoperative MR imaging can be safely performed and may assist in demonstrating acute changes involving intracranial hemorrhage and air during DBS surgery. These findings are rarely clinically significant and typically resolve prior to follow-up imaging. Selective use of T2 FLAIR and T2 FSE imaging can confirm the presence of hemorrhage or air and preclude the need for CT examinations.

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Magnetic resonance imaging techniques for visualization of the subthalamic nucleus

Journal of Neurosurgery ◽

10.3171/2011.6.jns101571 ◽

2011 ◽

Vol 115 (5) ◽

pp. 971-984 ◽

Cited By ~ 33

Author(s):

Ellen J. L. Brunenberg ◽

Bram Platel ◽

Paul A. M. Hofman ◽

Bart M. ter Haar Romeny ◽

Veerle Visser-Vandewalle

Keyword(s):

Deep Brain Stimulation ◽

Mr Imaging ◽

Subthalamic Nucleus ◽

Brain Stimulation ◽

Imaging Techniques ◽

Patient Specific ◽

Anatomical Landmarks ◽

Indirect Methods ◽

Direct Targeting ◽

Deep Brain

The authors reviewed 70 publications on MR imaging–based targeting techniques for identifying the subthalamic nucleus (STN) for deep brain stimulation in patients with Parkinson disease. Of these 70 publications, 33 presented quantitatively validated results. There is still no consensus on which targeting technique to use for surgery planning; methods vary greatly between centers. Some groups apply indirect methods involving anatomical landmarks, or atlases incorporating anatomical or functional data. Others perform direct visualization on MR imaging, using T2-weighted spin echo or inversion recovery protocols. The combined studies do not offer a straightforward conclusion on the best targeting protocol. Indirect methods are not patient specific, leading to varying results between cases. On the other hand, direct targeting on MR imaging suffers from lack of contrast within the subthalamic region, resulting in a poor delineation of the STN. These deficiencies result in a need for intraoperative adaptation of the original target based on test stimulation with or without microelectrode recording. It is expected that future advances in MR imaging technology will lead to improvements in direct targeting. The use of new MR imaging modalities such as diffusion MR imaging might even lead to the specific identification of the different functional parts of the STN, such as the dorsolateral sensorimotor part, the target for deep brain stimulation.

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Magnetic resonance imaging stereotactic target localization for deep brain stimulation in dystonic children

Journal of Neurosurgery ◽

10.3171/jns.2000.93.5.0784 ◽

2000 ◽

Vol 93 (5) ◽

pp. 784-790 ◽

Cited By ~ 70

Author(s):

Nathalie Vayssiere ◽

Simone Hemm ◽

Michel Zanca ◽

Marie Christine Picot ◽

Alain Bonafe ◽

...

Keyword(s):

Deep Brain Stimulation ◽

Magnetic Resonance ◽

Mr Imaging ◽

General Anesthesia ◽

Brain Stimulation ◽

Target Localization ◽

Electrode Implantation ◽

Content Type ◽

Fine Print ◽

Deep Brain

Object. The actual distortion present in a given series of magnetic resonance (MR) images is difficult to establish. The purpose of this study was to validate an MR imaging—based methodology for stereotactic targeting of the internal globus pallidus during electrode implantation in children in whom general anesthesia had been induced.Methods. Twelve children (mean follow up 1 year) suffering from generalized dystonia were treated with deep brain stimulation by using a head frame and MR imaging. To analyze the influence of distortions at every step of the procedure, the geometrical characteristics of the frame were first controlled using the localizer as a phantom. Then pre- and postoperative coordinates of fixed anatomical landmarks and electrode positions, both determined with the head frame in place, were statistically compared.No significant difference was observed between theoretical and measured dimensions of the localizer (Student's t-test, |t| > 2.2 for 12 patients) in the x, y, and z directions.No significant differences were observed (Wilcoxon paired-sample test) between the following: 1) pre- and postoperative coordinates of the anterior commissure (AC) (Δx = 0.3 ± 0.29 mm and Δy = 0.34 ± 0.32 mm) and posterior commissure (PC) (Δx = 0.15 ± 0.18 mm and Δy = 0.34 ± 0.25 mm); 2) pre- and postoperative AC—PC distance (ΔL = 0.33 ± 0.22 mm); and 3) preoperative target and final electrode position coordinates (Δx = 0.24 ± 0.22 mm; Δy = 0.19 ± 0.16 mm).Conclusions. In the authors' center, MR imaging distortions did not induce detectable errors during stereotactic surgery in dystonic children. Target localization and electrode implantation could be achieved using MR imaging alone after induction of general anesthesia. The remarkable postoperative improvement in these patients confirmed the accuracy of the procedure (Burke—Marsden—Fahn Dystonia Rating Scale score Δ = −83.8%).

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Effects of magnetic resonance imaging in patients with implanted deep brain stimulation systems

Journal of Neurosurgery ◽

10.3171/2010.1.jns09951 ◽

2010 ◽

Vol 113 (6) ◽

pp. 1242-1245 ◽

Cited By ~ 23

Author(s):

Valerie Fraix ◽

Stephan Chabardes ◽

Alexandre Krainik ◽

Eric Seigneuret ◽

Sylvie Grand ◽

...

Keyword(s):

Deep Brain Stimulation ◽

Mr Imaging ◽

Brain Stimulation ◽

Reed Switch ◽

Pulse Generators ◽

Dual Channel ◽

Before And After ◽

Clinical Consequences ◽

Safety Guidelines ◽

Deep Brain

Object The aim of this study was to study the effects of MR imaging on the electrical settings of deep brain stimulation (DBS) systems and their clinical consequences. Methods The authors studied the effects of 1.5-T MR imaging on the electrical settings of implanted DBS systems, including 1 or more monopolar or quadripolar leads, extension leads, and single- or dual-channel implantable pulse generators (IPGs). The IPG was switched off during the procedure and the voltage was set to 0. The impedances were checked before and after MR imaging. Results Five hundred seventy patients were treated with DBS for movement disorders and underwent brain MR imaging after lead implantation and before IPG implantation. None of the patients experienced any adverse events. Thirty-one of these patients underwent 61 additional MR imaging sessions after the entire DBS system had been implanted. The authors report neither local cutaneous nor neurological disorders during or after the MR imaging session. No change in the IPG settings occurred when the magnet reed switch function remained disabled during the procedure. Conclusions This study demonstrates that 1.5-T MR imaging can be performed safely with continuous monitoring in patients with a DBS system. The ability to disable the magnet reed switch function of the IPG prevents any change in the electrical settings and thus any side effects. The increasing number of DBS indications and the widespread use of MR imaging indicates the need for defining safety guidelines for the use of MR imaging in patients with implanted neurostimulators.

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Frameless deep brain stimulation using intraoperative O-arm technology

Journal of Neurosurgery ◽

10.3171/2011.3.jns101642 ◽

2011 ◽

Vol 115 (2) ◽

pp. 301-309 ◽

Cited By ~ 39

Author(s):

Adam P. Smith ◽

Roy A. E. Bakay

Keyword(s):

Deep Brain Stimulation ◽

Mr Imaging ◽

Radiation Exposure ◽

Brain Stimulation ◽

Brain Shift ◽

Intended Target ◽

Electrophysiological Testing ◽

Euclidean Distances ◽

Lead Location ◽

Deep Brain

Object Correct lead location in the desired target has been proven to be a strong influential factor for good clinical outcome in deep brain stimulation (DBS) surgery. Commonly, a surgeon's first reliable assessment of such location is made on postoperative imaging. While intraoperative CT (iCT) and intraoperative MR imaging have been previously described, the authors present a series of frameless DBS procedures using O-arm iCT. Methods Twelve consecutive patients with 15 leads underwent frameless DBS placement using electrophysiological testing and O-arm iCT. Initial target coordinates were made using standard indirect and direct assessment. Microelectrode recording (MER) with kinesthetic responses was performed, followed by microstimulation to evaluate the side-effect profile. Intraoperative 3D CT acquisitions obtained between each MER pass and after final lead placement were fused with the preoperative MR image to verify intended MER movements around the target area and to identify the final lead location. Tip coordinates from the initial plan, final intended target, and actual lead location on iCT were later compared with the lead location on postoperative MR imaging, and euclidean distances were calculated. The amount of radiation exposure during each procedure was calculated and compared with the estimated radiation exposure if iCT was not performed. Results The mean euclidean distances between the coordinates for the initial plan, final intended target, and actual lead on iCT compared with the lead coordinates on postoperative MR imaging were 3.04 ± 1.45 mm (p = 0.0001), 2.62 ± 1.50 mm (p = 0.0001), and 1.52 ± 1.78 mm (p = 0.0052), respectively. The authors obtained good merging error during image fusion, and postoperative brain shift was minimal. The actual radiation exposure from iCT was invariably less than estimates of exposure using standard lateral fluoroscopy and anteroposterior radiographs (p < 0.0001). Conclusions O-arm iCT may be useful in frameless DBS surgery to approximate microelectrode or lead locations intraoperatively. Intraoperative CT, however, may not replace fundamental DBS surgical techniques such as electrophysiological testing in movement disorder surgery. Despite the lack of evidence for brain shift from the procedure, iCT-measured coordinates were statistically different from those obtained postoperatively, probably indicating image merging inaccuracy and the difficulties in accurately denoting lead location. Therefore, electrophysiological testing may truly be the only means of precisely knowing the location in 3D space intraoperatively. While iCT may provide clues to electrode or lead location during the procedure, its true utility may be in DBS procedures targeting areas where electrophysiology is less useful. The use of iCT appears to reduce radiation exposure compared with the authors' traditional frameless technique.

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MR imaging central thalamic deep brain stimulation restored autistic-like social deficits in the rat

Brain Stimulation ◽

10.1016/j.brs.2019.07.004 ◽

2019 ◽

Vol 12 (6) ◽

pp. 1410-1420

Author(s):

Ting-Chun Lin ◽

Yu-Chun Lo ◽

Hui-Ching Lin ◽

Ssu-Ju Li ◽

Sheng-Huang Lin ◽

...

Keyword(s):

Deep Brain Stimulation ◽

Mr Imaging ◽

Brain Stimulation ◽

Social Deficits ◽

Deep Brain

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2.301 DIRECT TARGETING THE SUBTHALAMIC NUCLEUS WITH 3.0T MR IMAGING FOR DEEP BRAIN STIMULATION

Parkinsonism & Related Disorders ◽

10.1016/s1353-8020(11)70624-1 ◽

2012 ◽

Vol 18 ◽

pp. S141

Author(s):

Y.-C. Shi ◽

Y.-M. Wang

Keyword(s):

Deep Brain Stimulation ◽

Mr Imaging ◽

Subthalamic Nucleus ◽

Brain Stimulation ◽

Direct Targeting ◽

Deep Brain

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A Computerized Microelectrode Recording to Magnetic Resonance Imaging Mapping System for Subthalamic Nucleus Deep Brain Stimulation Surgery

Operative Neurosurgery ◽

10.1093/ons/opx169 ◽

2017 ◽

Vol 14 (6) ◽

pp. 661-667

Author(s):

Sunjay S Dodani ◽

Charles W Lu ◽

J Wayne Aldridge ◽

Kelvin L Chou ◽

Parag G Patil

Keyword(s):

Deep Brain Stimulation ◽

Magnetic Resonance ◽

Subthalamic Nucleus ◽

Brain Stimulation ◽

Microelectrode Recording ◽

Mr Images ◽

Electrode Localization ◽

Voxel Intensity ◽

Stn Dbs ◽

Deep Brain

Abstract BACKGROUND Accurate electrode placement is critical to the success of deep brain stimulation (DBS) surgery. Suboptimal targeting may arise from poor initial target localization, frame-based targeting error, or intraoperative brain shift. These uncertainties can make DBS surgery challenging. OBJECTIVE To develop a computerized system to guide subthalamic nucleus (STN) DBS electrode localization and to estimate the trajectory of intraoperative microelectrode recording (MER) on magnetic resonance (MR) images algorithmically during DBS surgery. METHODS Our method is based upon the relationship between the high-frequency band (HFB; 500-2000 Hz) signal from MER and voxel intensity on MR images. The HFB profile along an MER trajectory recorded during surgery is compared to voxel intensity profiles along many potential trajectories in the region of the surgically planned trajectory. From these comparisons of HFB recordings and potential trajectories, an estimate of the MER trajectory is calculated. This calculated trajectory is then compared to actual trajectory, as estimated by postoperative high-resolution computed tomography. RESULTS We compared 20 planned, calculated, and actual trajectories in 13 patients who underwent STN DBS surgery. Targeting errors for our calculated trajectories (2.33 mm ± 0.2 mm) were significantly less than errors for surgically planned trajectories (2.83 mm ± 0.2 mm; P = .01), improving targeting prediction in 70% of individual cases (14/20). Moreover, in 4 of 4 initial MER trajectories that missed the STN, our method correctly indicated the required direction of targeting adjustment for the DBS lead to intersect the STN. CONCLUSION A computer-based algorithm simultaneously utilizing MER and MR information potentially eases electrode localization during STN DBS surgery.

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