Methodological Considerations for Neuroimaging in Deep Brain Stimulation of the Subthalamic Nucleus in Parkinson’s Disease Patients

Abstract

Deep brain stimulation (DBS) of the subthalamic nucleus is a neurosurgical intervention for Parkinson’s disease patients who no longer appropriately respond to drug treatments. A small fraction of patients will fail to respond to DBS, develop psychiatric and cognitive side-effects, or incur surgery-related complications such as infections and hemorrhagic events. In these cases, DBS may require recalibration, reimplantation, or removal. These negative responses to treatment can partly be attributed to suboptimal pre-operative planning procedures via direct targeting through low-field and low-resolution magnetic resonance imaging (MRI). One solution for increasing the success and efficacy of DBS is to optimize preoperative planning procedures via sophisticated neuroimaging techniques such as high-resolution MRI and higher field strengths to improve visualization of DBS targets and vasculature. We discuss targeting approaches, MRI acquisition, parameters, and post-acquisition analyses. Additionally, we highlight a number of approaches including the use of ultra-high field (UHF) MRI to overcome limitations of standard settings. There is a trade-off between spatial resolution, motion artifacts, and acquisition time, which could potentially be dissolved through the use of UHF-MRI. Image registration, correction, and post-processing techniques may require combined expertise of traditional radiologists, clinicians, and fundamental researchers. The optimization of pre-operative planning with MRI can therefore be best achieved through direct collaboration between researchers and clinicians.

Effects of STN‐DBS surgery on cerebral glucose metabolism and distribution of DAT in Parkinson's disease

“…Additionally, PD is characterized by various motor symptoms, including gait abnormalities, speech impairments, postural disturbances, and postural instability, which are associated with disruptions in non‐dopaminergic transmission. Furthermore, PD presents a range of non‐motor symptoms, such as cognitive dysfunction, sleep disturbances, reduced sense of smell (hyposmia), depression, and anxiety (Bloem et al., 2021 ; Isaacs et al., 2020 ). Although levodopa and other medications can alleviate symptoms for a period of time, drug‐induced dyskinesia and motor fluctuations are common in the late stages of PD for most patients (Evans & Lees, 2004 ; Lang & Obeso, 2004 ; Olanow et al., 2006 ).…”

DeepNavNet: Automated Landmark Localization for Neuronavigation

“…In contrast, "direct" targeting methods may be used when targeted structures are visible and directly identifiable in preoperative images, e.g., acquired using special MRI sequences designed to target specific structures, acquired in an ultra-high field MRI scanner, or in visualizations created through multimodal fusion techniques (Cho et al, 2010;Grewal et al, 2018Grewal et al, , 2020Hartmann et al, 2019). Despite advances in visualizations and direct targeting methods, manual localization of AC and PC points remain standard practice and ACPC alignment is valuable beyond targeting such as for multimodal visualizations for pre-and post-operative assessments (Isaacs et al, 2020). The locations of deep brain surgical targets are estimated by defining a distance from the mid AC-PC point and crosschecked against the registered atlas.…”

Special Issue: Trends in Clinical Deep Brain Stimulation

“…Of utmost importance to achieve an optimal lead placement is the quality of the planning based on magnetic resonance imaging (MRI). Our imaging group provided a critical viewpoint on the optimization of pre-operative imaging at the level of acquisition, data-processing and planning software [ 10 ]. The individual success of DBS relates considerably to psychological aspects.…”