Statistical Shape Analysis of Subthalamic Nucleus in Patients with Parkinson Disease

Kaya, Mehmet; Öztürk, Sait; Ercan, İlker; Gönen, Murat; Erol, Fatih Serhat; Kocabıcak, Ersoy

doi:10.1016/j.wneu.2019.02.180

Cited by 16 publications

(18 citation statements)

References 18 publications

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“…Although the final placement of DBS leads is a clinical decision that depends on a myriad of factors, placing the electrode tip near the SSB is still recommended by most neurosurgeons to ensure better coverage of motor STN and fewer side effects (5,11). During the surgery, it is often very difficult to determine where to stop in the STN because the signal near the ventral boundary of the STN is sometimes elusive (6,11,25). The gap between the STN and SNr can be very small that surgeons can misinterpret the SNr signal as the STN signal.…”

Section: Discussionmentioning

confidence: 99%

Microstimulation Is a Promising Approach in Achieving Better Lead Placement in Subthalamic Nucleus Deep Brain Stimulation Surgery

et al. 2021

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Background: The successful application of subthalamic nucleus (STN) deep brain stimulation (DBS) surgery relies mostly on optimal lead placement, whereas the major challenge is how to precisely localize STN. Microstimulation, which can induce differentiating inhibitory responses between STN and substantia nigra pars reticulata (SNr) near the ventral border of STN, has indicated a great potential of breaking through this barrier.Objective: This study aims to investigate the feasibility of localizing the boundary between STN and SNr (SSB) using microstimulation and promote better lead placement.Methods: We recorded neurophysiological data from 41 patients undergoing STN-DBS surgery with microstimulation in our hospital. Trajectories with typical STN signal were included. Microstimulation was applied near the bottom of STN to determine SSB, which was validated by the imaging reconstruction of DBS leads.Results: In most trajectories with microstimulation (84.4%), neuronal firing in STN could not be inhibited by microstimulation, whereas in SNr long inhibition was observed following microstimulation. The success rate of localizing SSB was significantly higher in trajectories with microstimulation than those without. Moreover, results from imaging reconstruction and intraoperative neurological assessments demonstrated better lead location and higher therapeutic effectiveness in trajectories with microstimulation and accurately identified SSB.Conclusion: Microstimulation on microelectrode recording is an effective approach to localize the SSB. Our data provide clinical evidence that microstimulation can be routinely employed to achieve better lead placement.

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Section: Discussionmentioning

confidence: 99%

Microstimulation Is a Promising Approach in Achieving Better Lead Placement in Subthalamic Nucleus Deep Brain Stimulation Surgery

et al. 2021

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“…The main reasons for the widespread use of this method in the field of medicine includes recent advances in imaging technology and the increased interest to investigate the effects of diseases and environmental factors on the structure of the tissues [ 23 ] . The statistical shape analysis method contributes to the morphometric evaluation of human anatomy [ 5 ] . In addition, it is a useful tool for postoperative tissue remodeling, which is of clinical relevance in daily practice [ 24 ] .…”

Section: Discussionmentioning

confidence: 99%

“…In recent years, a considerable number of studies based on the geometric characteristics of organs or organisms investigating the change in the geometric properties of these structures with a specific disease or environmental factors have been reported in the literature [ 5 , 6 ] . The statistical shape analysis method is a modern geometric morphometric method that utilizes the shape of organs or organisms as input data.…”

Section: Introductionmentioning

confidence: 99%

Retrosternal Deformations after Coronary Artery Bypass Surgery Using Statistical Shape Analysis

Bademci

Ocakoğlu

Kocaaslan

et al. 2021

Braz J Cardiovasc Surg

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Introduction In this study, we aimed to evaluate the anatomical deformations of the major vascular structures in the retrosternal area caused by adhesions following coronary artery bypass grafting (CABG). Methods This single-center, retrospective study included a total of 40 patients with a previous CABG who were admitted to our emergency unit for any reason and underwent a contrast-enhanced chest computed tomography (patient group) and 40 patients without previous cardiac surgery (control group) between January 2018 and November 2019. The retrosternal area was compared between the groups using the statistical shape analysis method. The distance between the sternum and the ascending aorta and pulmonary artery was measured and anatomical deformations of the retrosternal area were examined. Results There was a statistically significant difference in the anatomical structures of the retrosternal area between the patient and control groups ( P <0.001). The distance from the midsternal line to the highest point of the pulmonary artery was statistically significantly shorter in the patient group, compared to the control group ( P =0.013). The distance from the sternum to the ascending aorta was also shorter in the patient group, although it did not reach statistical significance ( P >0.05). Conclusions Our study results showed narrowing of the retrosternal area following CABG and a shorter distance from the sternum to the pulmonary artery than the ascending aorta. Based on these findings, surgeons should be cautious about possible injuries in patients requiring cardiac surgery with repeated median sternotomy.

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“…Direct targeting with patient-specific MRI is generally preferred as the STN is known to shift with both age and disease, as well as vary in size, shape, and location across individuals [ 43 , 44 , 45 , 46 , 47 ]. Clinical MRI typically visualizes the STN using T2-weighted (T2w) images, which present the nucleus as a hypointense region relative to surrounding tissue.…”

Section: Using Mri To Target the Stn In Pd For Dbsmentioning

confidence: 99%

“…Moreover, the STN is an inherently difficult structure to visualize as it is a small structure located within a very deep and dense portion of the basal ganglia and is surrounded by structures containing similar chemical compositions. This is exemplified by vast inconsistencies in observed volumetric measures, size, and location estimates of subcortical nuclei reported at low field strengths [ 44 , 45 , 46 ].…”

Section: Field Strengthmentioning

confidence: 99%

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

Isaacs

Keuken

Alkemade

et al. 2020

JCM

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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.

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Statistical Shape Analysis of Subthalamic Nucleus in Patients with Parkinson Disease

Cited by 16 publications

References 18 publications

Microstimulation Is a Promising Approach in Achieving Better Lead Placement in Subthalamic Nucleus Deep Brain Stimulation Surgery

Microstimulation Is a Promising Approach in Achieving Better Lead Placement in Subthalamic Nucleus Deep Brain Stimulation Surgery

Retrosternal Deformations after Coronary Artery Bypass Surgery Using Statistical Shape Analysis

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

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