Neuroimaging Advances in Deep Brain Stimulation: Review of Indications, Anatomy, and Brain Connectomics

Abstract

Deep brain stimulation is an established therapy for multiple brain disorders, with rapidly expanding potential indications. Neuroimaging has advanced the field of deep brain stimulation through improvements in delineation of anatomy, and, more recently, application of brain connectomics. Older lesion-derived, localizationist theories of these conditions have evolved to newer, network-based "circuitopathies," aided by the ability to directly assess these brain circuits in vivo through the use of advanced neuroimaging techniques, such as diffusion tractography and fMRI. In this review, we use a combination of ultra-high-field MR imaging and diffusion tractography to highlight relevant anatomy for the currently approved indications for deep brain stimulation in the United States: essential tremor, Parkinson disease, drug-resistant epilepsy, dystonia, and obsessive-compulsive disorder. We also review the literature regarding the use of fMRI and diffusion tractography in understanding the role of deep brain stimulation in these disorders, as well as their potential use in both surgical targeting and device programming. ABBREVIATIONS: AL ¼ ansa lenticularis; ALIC ¼ anterior limb of the internal capsule; ANT ¼ anterior nucleus of the thalamus; AS ¼ ansa subthalamica; ATR ¼ anterior thalamic radiations; DBS ¼ deep brain stimulation; DRTT ¼ dentatorubrothalamic tract; ET ¼ essential tremor; FGATIR ¼ fast gray matter acquisition T1 inversion recovery; FL ¼ fasciculus lenticularis; FS ¼ fasciculus subthalamicus; GPe ¼ globus pallidus externus; GPi ¼ globus pallidus internus; MFB ¼ medial forebrain bundle; MMT ¼ mammillothalamic tract; OCD ¼ obsessive-compulsive disorder; PD ¼ Parkinson disease; slMFB ¼ superolateral branch of the medial forebrain bundle; STN ¼ subthalamic; TF ¼ thalamic fasciculus; VIM ¼ ventral intermedius nucleus; VO ¼ ventralis oralis; ZI ¼ zona incerta

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