Comparison of Different Targeting Methods for Subthalamic Nucleus Deep Brain Stimulation

Abstract

Abstract. The subthalamic nucleus (STN) has been adopted as a commonly used surgical target in deep brain stimulation (DBS) procedures for the treatment of Parkinson's disease. Many techniques have been developed to facilitate STN DBS targeting, and consequently to improve the surgical outcome. In this work, we conducted a retrospective study on 10 patients who were treated with bilateral STN DBS to assess the target localization accuracy and precision of six methods in STN DBS surgery. A visualization and navigation system integrated with normalized functional and anatomical information was employed to perform the targeting procedures. Actual surgical target location determined by an experienced neurosurgeon with pre-operative image-guided surgical target/trajectory planning and intra-operative electrophysiological exploration and confirmation was considered as the "gold standard" in this evaluation and was compared with those localized using each of the six targeting methods. The mean distance between the actual surgical targets and those planned was 3.0 ± 1.3mm, 3.2± 1.1mm, 2.9 ± 1.1mm, 2.7 ± 1.2mm, 2.5 ± 1.0mm, and 1.7 ± 0.8mm for targeting approaches based on T 2 -weighted magnetic resonance image (MRI), brain atlas, T 1 and T 2 maps, electrophysiological database, collection of final surgical targets of previous patients, and the combination of these functional and anatomical data respectively. The results demonstrated that the use of functional data along with anatomical data provides reliable and accurate target position for STN DBS.

Imaging for deep brain stimulation: The zona incerta at 7 Tesla

“…Besides the most frequently used heavily T2-weighted fast spin-echo [20,31,38] new sequences including quantitative T1 and T2 imaging [39,40] , T2* mapping [41][42][43] and susceptibility-weighted imaging (SWI) [44] , have been proposed to improve the visibility of the target structures. For the ZI no respective data exists.…”

Surgical targeting accuracy analysis of six methods for subthalamic nucleus deep brain stimulation

“…This paper extends earlier work [26] through a more comprehensive retrospective study to evaluate and compare the target localization accuracy and precision of six targeting methods in STN DBS surgery. We addressed three questions in this study: (1) What is the spatial correlation between the actual surgical target and the predicted surgical target based on each targeting method?…”

“…In addition, registered surgical targets from previous patients [24], as well as integration of multiple functional and anatomical references [25,26], may also be employed to facilitate STN DBS surgical targeting. Although the STN is often distinguishable on patient-specific T 2 -weighted MR images, which allow better visualization of this nucleus, the discrepancy between the target positions localized with T 2 -weighted MR images and those finalized using electrophysiological measurements should be taken into consideration, and the use of T 2 -weighted MR images alone should be employed cautiously [27,28].…”

Automatic Target and Trajectory Identification for Deep Brain Stimulation (DBS) Procedures

“…Recently, Yelnik et al described a 3D deformable histological atlas of the human basal ganglia [4] that contained functional information derived from immunohistochemical studies. In addition, functional atlases [5,6] and databases [7] containing intra-operatively acquired subcortical electrophysiology from a number of patients have been implemented to complement the anatomical and histological atlases. Precise localization of the target is more likely to be achieved with the assistance of pre-operatively available electrophysiological information [7].…”

“…In addition, functional atlases [5,6] and databases [7] containing intra-operatively acquired subcortical electrophysiology from a number of patients have been implemented to complement the anatomical and histological atlases. Precise localization of the target is more likely to be achieved with the assistance of pre-operatively available electrophysiological information [7]. This paper focuses on constructing 3D probabilistic maps of functional data and integrating these maps into our neurosurgical system to accomplish automatic target and trajectory identification for DBS procedures.…”