Integrating Diffusion Tensor Imaging-Based Tractography into Deep Brain Stimulation Surgery: A Review of the Literature

Torres, Cristina V.; Manzanares, Rafael; Sola, Rafael G.

doi:10.1159/000362937

Cited by 24 publications

(25 citation statements)

References 64 publications

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“…Although it is generally agreed on that effects of DBS are exerted on fibers, there is only limited published evidence on DTI tractography-assisted stereotactic surgery [23]. A post hoc study of our group in 11 patients who received Vim-DBS was able to show that effective electrode positions are located inside or within proximity of the DRT [12], extending knowledge gathered by Klein et al [24] and Coenen et al [10,11].…”

Section: Discussionsupporting

confidence: 72%

Deep Brain Stimulation for Tremor Tractographic Versus Traditional (DISTINCT): Study Protocol of a Randomized Controlled Feasibility Trial

et al. 2016

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BackgroundEssential tremor is a movement disorder that can result in profound disability affecting the quality of life. Medically refractory essential tremor can be successfully reduced by deep brain stimulation (DBS) traditionally targeting the thalamic ventral intermediate nucleus (Vim). Although this structure can be identified with magnetic resonance (MR) imaging nowadays, Vim-DBS electrodes are still implanted in the awake patient with intraoperative tremor testing to achieve satisfactory tremor control. This can be attributed to the fact that the more effective target of DBS seems to be the stimulation of fiber tracts rather than subcortical nuclei like the Vim. There is evidence that current coverage of the dentatorubrothalamic tract (DRT) results in good tremor control in Vim-DBS. Diffusion tensor MR imaging (DTI) tractography-assisted stereotactic surgery targeting the DRT would therefore not rely on multiple trajectories and intraoperative tremor testing in the awake patient, bearing the potential of more patient comfort and reduced operation-related risks. This is the first randomized controlled trial comparing DTI tractography-assisted stereotactic surgery targeting the DRT in general anesthesia with stereotactic surgery of thalamic/subthalamic region as conventionally used.ObjectiveThis clinical pilot trial aims at demonstrating safety of DTI tractography-assisted stereotactic surgery in general anesthesia and proving its equality compared to conventional stereotactic surgery with intraoperative testing in the awake patient.MethodsThe Deep Brain Stimulation for Tremor Tractographic Versus Traditional (DISTINCT) trial is a single-center investigator-initiated, randomized, controlled, observer-blinded trial. A total of 24 patients with medically refractory essential tremor will be randomized to either DTI tractography-assisted stereotactic surgery targeting the DRT in general anesthesia or stereotactic surgery of the thalamic/subthalamic region as conventionally used. The primary objective is to assess the tremor reduction, obtained by the Fahn-Tolosa-Marin Tremor Rating Scale in the 2 treatment groups. Secondary objectives include (among others) assessing the quality of life, optimal electrode contact positions, and safety of the intervention. The study protocol has been approved by the independent ethics committee of the University of Freiburg.ResultsRecruitment to the DISTINCT trial opened in September 2015 and is expected to close in June 2017. At the time of manuscript submission the trial is open to recruitment.ConclusionsThe DISTINCT trial is the first to compare DTI tractography-assisted stereotactic surgery with target point of the DRT in general anesthesia to stereotactic surgery of the thalamic/subthalamic region as conventionally used. It can serve as a cornerstone for the evolving technique of DTI tractography-assisted stereotactic surgery.ClinicalTrialClinicalTrials.gov NCT02491554; https://clinicaltrials.gov/ct2/show/NCT02491554 (Archived by WebCite at http://www.webcitation.org/6mezLnB9...

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Section: Discussionsupporting

confidence: 72%

Deep Brain Stimulation for Tremor Tractographic Versus Traditional (DISTINCT): Study Protocol of a Randomized Controlled Feasibility Trial

et al. 2016

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“…Although some studies show unaltered forniceal white matter in depression [72], future forniceal subregional analysis may help explain these discrepancies [73]. Although the mechanisms through which DBS exerts its impact are complex and incompletely understood [74], growing evidence supports a greater influence on diffuse white matter tracts, compared to gray matter, suggesting that methods focused on improving tract visualization, such as tractography, will be of great importance in DBS target planning in future [75]. Together, these results show that poorer pre-DBS dMRI metrics (i.e.…”

Section: Implications For Using Dmri and Dbs In Anorexia Nervosamentioning

confidence: 99%

“…Also, as DBS does not result in clinical improvements for all people with major depressive disorder [62,77], it will be important going forward to precisely determine which anorexia nervosa patients respond best to DBS. Regardless, it appears that dMRI techniques, including mutli-tensor tractography, will be key in determining the best targeting for such effects and may eventually become part of standard pre-surgical planning [75,78,79].…”

Section: Implications For Using Dmri and Dbs In Anorexia Nervosamentioning

confidence: 99%

Subcallosal Cingulate Connectivity in Anorexia Nervosa Patients Differs From Healthy Controls: A Multi-tensor Tractography Study

et al. 2015

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“…Similarly, the effect of deep brain stimulation (DBS) is predicted by connectomics and may be mediated by white matter. 36,48,58,84 Thus, Figee et al demonstrated that stimulation of the nucleus accumbens in obsessive-compulsive disorder normalized nucleus accumbens activity but also critically reduced its increased (functional) connectivity with the prefrontal cortex as well as frontal low-frequency oscillations during symptoms. 31 Regarding depression, DBS targeting the subgenual cortex/subcallosal cingulate cortex (which is currently the most effective target) is mediated by its impact on white matter rather than by direct cortical activations.…”

Section: Toward Individually Targeted Psychosurgerymentioning

confidence: 99%

Neuroplasticity and the brain connectome: what can Jean Talairach’s reflections bring to modern psychosurgery?

Bourdillon

Apra

Lévêque

et al. 2017

Neurosurgical Focus

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Contrary to common psychosurgical practice in the 1950s, Dr. Jean Talairach had the intuition, based on clinical experience, that the brain connectome and neuroplasticity had a role to play in psychosurgery. Due to the remarkable progress of pharmacology at that time and to the technical limits of neurosurgery, these concepts were not put into practice. Currently, these concepts are being confirmed by modern techniques such as neuroimaging and computational neurosciences, and could pave the way for therapeutic innovation in psychiatry.Psychosurgery commonly uses a localizationist approach, based on the idea that a lesion to a specific area is responsible for a deficit opposite to its function. To psychosurgeons such as Walter Freeman, who performed extensive lesions causing apparently inevitable deficit, Talairach answered with clinical data: complex psychic functions cannot be described that simply, because the same lesion does not provoke the same deficit in different patients. Moreover, cognitive impairment did not always follow efficacious psychosurgery. Talairach suggested that selectively destructing part of a network could open the door to a new organization, and that early psychotherapy could encourage this psychoplasticity. Talairach did not have the opportunity to put these concepts into practice in psychiatric diseases because of the sudden availability of neuroleptics, but connectomics and neuroplasticity gave rise to major advances in intraparenchymal neurosurgery, from epilepsy to low-grade glioma. In psychiatry, alongside long-standing theories implicating focal lesions and diffuse pathological processes, neuroimaging techniques are currently being developed. In mentally healthy individuals, combining diffusion tensor imaging with functional MRI, magnetoencephalography, and electroencephalography allows the determination of a comprehensive map of neural connections in the brain on many spatial scales, the so-called connectome. Ultimately, global neurocomputational models could predict physiological activity, behavior, and subjective feeling, and describe neuropsychiatric disorders.Connectomic studies comparing psychiatric patients with controls have already confirmed the early intuitions of Talairach. As a striking example, massive dysconnectivity has been found in schizophrenia, leading some authors to propose a “dysconnection hypothesis.” Alterations of the connectome have also been demonstrated in obsessive-compulsive disorder and depression. Furthermore, normalization of the functional dysconnectivity has been observed following clinical improvement in several therapeutic interventions, from psychotherapy to pharmacological treatments. Provided that mental disorders result from abnormal structural or functional wiring, targeted psychosurgery would require that one be able: 1) to identify the pathological network involved in a given patient; 2) to use neurostimulation to safely create a reversible and durable alteration, mimicking a lesion, in a network compatible with neuroplasticity; and 3) to predict which functional lesion would result in adapted neuronal plasticity and/or to guide neuronal plasticity to promote recovery. All these conditions, already suggested by Talairach, could now be achievable considering modern biomarkers and surgical progress.

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Integrating Diffusion Tensor Imaging-Based Tractography into Deep Brain Stimulation Surgery: A Review of the Literature

Cited by 24 publications

References 64 publications

Deep Brain Stimulation for Tremor Tractographic Versus Traditional (DISTINCT): Study Protocol of a Randomized Controlled Feasibility Trial

Deep Brain Stimulation for Tremor Tractographic Versus Traditional (DISTINCT): Study Protocol of a Randomized Controlled Feasibility Trial

Subcallosal Cingulate Connectivity in Anorexia Nervosa Patients Differs From Healthy Controls: A Multi-tensor Tractography Study

Neuroplasticity and the brain connectome: what can Jean Talairach’s reflections bring to modern psychosurgery?

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