Interventional magnetic resonance imaging-guided subthalamic nucleus deep brain stimulation for Parkinson′s disease: Patient selection

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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The Role of 3T Magnetic Resonance Imaging for Targeting the Human Subthalamic Nucleus in Deep Brain Stimulation for Parkinson Disease

Journal of Neurological Surgery Part A Central European Neurosurgery ◽

10.1055/s-0033-1354749 ◽

2015 ◽

Vol 76 (03) ◽

pp. 181-189 ◽

Cited By ~ 10

Author(s):

Giuseppe Ricciardi ◽

Giorgio Tommasi ◽

Antonio Nicolato ◽

Roberto Foroni ◽

Laura Bertolasi ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Deep Brain Stimulation ◽

Magnetic Resonance ◽

Parkinson Disease ◽

Subthalamic Nucleus ◽

Brain Stimulation ◽

Resonance Imaging ◽

Deep Brain

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Targeting Accuracy of the Subthalamic Nucleus in Deep Brain Stimulation Surgery: Comparison Between 3 T T2-Weighted Magnetic Resonance Imaging and Microelectrode Recording Results

Operative Neurosurgery ◽

10.1093/ons/opx175 ◽

2017 ◽

Vol 15 (1) ◽

pp. 66-71 ◽

Cited By ~ 8

Author(s):

Andreas Nowacki ◽

Ines Debove ◽

Michael Fiechter ◽

Frédéric Rossi ◽

Markus Florian Oertel ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Deep Brain Stimulation ◽

Magnetic Resonance ◽

Subthalamic Nucleus ◽

Brain Stimulation ◽

Microelectrode Recording ◽

Resonance Imaging ◽

Entry Points ◽

Targeting Accuracy ◽

Deep Brain

Abstract BACKGROUND Targeting accuracy in deep brain stimulation (DBS) surgery can be defined as the level of accordance between selected and anatomic real target reflected by characteristic electrophysiological results of microelectrode recording (MER). OBJECTIVE To determine the correspondence between the preoperative predicted target based on modern 3-T magnetic resonance imaging (MRI) and intraoperative MER results separately on the initial and consecutive second side of surgery. METHODS Retrospective cohort study of 86 trajectories of DBS electrodes implanted into the subthalamic nucleus (STN) of patients with Parkinson's disease. The entrance point of the electrode into the STN and the length of the electrode trajectory crossing the STN were determined by intraoperative MER findings and 3 T T2-weighted magnetic resonance images with 1-mm slice thickness. RESULTS Average difference between MRI- and MER-based trajectory lengths crossing the STN was 0.28 ± 1.02 mm (95% CI: −0.51 to −0.05 mm). There was a statistically significant difference between the MRI- and MER-based entry points on the initial and second side of surgery (P = .04). Forty-three percent of the patients had a difference of more than ±1 mm of the MRI-based-predicted and the MER-based-determined entry points into the STN with values ranging from −3.0 to + 4.5 mm. CONCLUSION STN MRI-based targeting is accurate in the majority of cases on the first and second side of surgery. In 43% of implanted electrodes, we found a relevant deviation of more than 1 mm, supporting the concept of MER as an important tool to guide and optimize targeting and electrode placement.

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