Targeting the subthalamic nucleus for deep brain stimulation: technical approach and fusion of pre- and postoperative MR images to define accuracy of lead placement

Hamid, N A; Mitchell, Rosalind; Mocroft, P; Westby, G. W. Max; Milner, Jessica; Pall, Hardev

doi:10.1136/jnnp.2003.032029

Cited by 128 publications

(71 citation statements)

References 23 publications

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“…8,9,28 In functional neurosurgery, one well-described brain location of interest is the STN. 5,6,27 Reports have shown that misplacement of an electrode by as little as 2 mm can cause ineffective stimulation and poor clinical outcome. 10,21,27 In the deep structures surrounding the STN we found that 4 patients (9%) had recorded amounts of shift of more than 2 mm.…”

Section: Magnitude and Quantification Of Shiftmentioning

confidence: 99%

Brain shift during bur hole–based procedures using interventional MRI

Ivan¹,

Yarlagadda

Saxena

et al. 2014

JNS

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Object. Brain shift during minimally invasive, bur hole-based procedures such as deep brain stimulation (DBS) electrode implantation and stereotactic brain biopsy is not well characterized or understood. We examine shift in various regions of the brain during a novel paradigm of DBS electrode implantation using interventional imaging throughout the procedure with high-field interventional MRI.Methods. Serial MR images were obtained and analyzed using a 1.5-T magnet prior to, during, and after the placement of DBS electrodes via frontal bur holes in 44 procedures. Three-dimensional coordinates in MR space of unique superficial and deep brain structures were recorded, and the magnitude, direction, and rate of shift were calculated. Measurements were recorded to the nearest 0.1 mm.Results. Shift ranged from 0.0 to 10.1 mm throughout all structures in the brain. The greatest shift was seen in the frontal lobe, followed by the temporal and occipital lobes. Shift was also observed in deep structures such as the anterior and posterior commissures and basal ganglia; shift in the pallidum and subthalamic region ipsilateral to the bur hole averaged 0.6 mm, with 9% of patients having over 2 mm of shift in deep brain structures. Small amounts of shift were observed during all procedures; however, the initial degree of shift and its direction were unpredictable.Conclusions. Brain shift is continual and unpredictable and can render traditional stereotactic targeting based on preoperative imaging inaccurate even in deep brain structures such as those used for DBS. This article contains some figures that are displayed in color on line but in black-and-white in the print edition.M. E. Ivan et al. 150J Neurosurg / Volume 121 / July 2014 pressure) or to mechanical force on the brain resulting from the intracranial passage of guidance catheters. Methods Patient Selection and DemographicsA total of 39 patients underwent 47 consecutive operations for implantation of a deep brain stimulator for either Parkinson's disease (PD) or dystonia at the University of California, San Francisco (UCSF) Medical Center. These patients underwent unilateral or bilateral placement of their DBS electrodes via a bur hole procedure. Table 1 shows the patient population, procedure, location, target, and disease process. Three surgeries were excluded from the analysis. One patient was intentionally moved between MRI sequences, invalidating the methodology used to assess brain shift. In 2 additional cases, data were analyzed but the control values for fixed points in the cranium were above our acceptable threshold (> 0.5 mm, see below). Therefore, 44 separate operations were included in this study. Six patients were operated on twice either due to staged unilateral placement of stimulators (5 patients) or replacement of stimulators after infection (1 patient). The average age at the time of surgery was 58 ± 13 years old, and 48% of the patients were female. Fifteen patients had unilateral stimulator placement and 29 had bilateral placement. The target was t...

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Section: Magnitude and Quantification Of Shiftmentioning

confidence: 99%

Brain shift during bur hole–based procedures using interventional MRI

Ivan¹,

Yarlagadda

Saxena

et al. 2014

JNS

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“…64 It has been shown that 3T MR imaging allows direct visualization of the STN on contiguous high-resolution T2-weighted fast spin-echo images. 58 Other authors compared the location of the STN as obtained by direct localization at 3T with a computer-aided atlas-based procedure for automatic STN identification and showed that there was good agreement between the direct identification of the STN at 3T and the automatically identified structures.…”

Section: Practical Determination Of Target Coordinatesmentioning

confidence: 99%

Neuroimaging and Deep Brain Stimulation

Dormont¹,

Seidenwurm²,

Galanaud³

et al. 2009

AJNR Am J Neuroradiol

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SUMMARY: Deep brain stimulation (DBS) is a new neurosurgical method principally used for the treatment of Parkinson disease (PD).Many new applications of DBS are under development, including the treatment of intractable psychiatric diseases. Brain imaging is used for the selection of patients for DBS, to localize the target nucleus, to detect complications, and to evaluate the final electrode contact position. In patients with implanted DBS systems, there is a risk of electrode heating when MR imaging is performed. This contraindicates MR imaging unless specific precautions are taken. Involvement of neuroradiologists in DBS procedures is essential to optimize presurgical evaluation, targeting, and postoperative anatomic results. The precision of the neuroradiologic correlation with anatomic data and clinical outcomes in DBS promises to yield significant basic science and clinical advances in the future. Chronic high-frequency stimulation of the ventral intermediate nucleus (VIM) of the thalamus was first described in the early 1990s by Benabid et al.1 These authors implanted chronic stimulating electrodes in the VIM connected to a subcutaneous pulse generator positioned in the thoracic region to treat disabling tremor in 26 patients with Parkinson disease (PD) and in 6 with essential tremor.1 They demonstrated the effectiveness of this technique and its ability to produce complete relief from tremor. Improvement was maintained for up to 29 months. This was the first clinical demonstration that chronic high-frequency stimulation of nuclei (deep brain stimulation [DBS]) could replace destructive lesion-producing functional neurosurgery such as thalamotomy. This new technique was reversible and led to a renaissance in functional neurosurgery.Next, the same team introduced bilateral DBS of the subthalamic nucleus (STN) in patients with disabling akineticrigid PD and severe motor fluctuations.2 This work extended data obtained in a 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine monkey model of PD showing that lesions and electric stimulation of the subthalamic nucleus reduced all of the major motor disturbances in this animal model. The results in patients with advanced PD were striking and were reproduced in many centers internationally. The US Food and Drug Administration approved the use of DBS for treatment of advanced PD with bilateral STN stimulation in 2002 and internal globus pallidus (GPi) stimulation in 2003. The main indication for DBS remains advanced PD, but numerous additional applications have been developed, ranging from dystonia to cluster headache, Tourette syndrome, and even psychiatric indications like obsessive-compulsive disorders (OCD) and major depression.DBS is a neurosurgical method, but the role of neuroimaging in successful DBS intervention is critical. Neuroimaging is used for the preoperative selection of patients who will have DBS and to localize the intended target nuclei. In the postoperative period, imaging detects complications that uncommonly accompany the procedure, confirms the pos...

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“…The percentage of the central-anatomical electrodes did not differ between the left and right sides, although there was a tendency towards a lower percentage of anatomical electrodes on the fi rst implanted left side (14). On the other hand, in the paper by Hamid et al, the authors found it easier to defi ne the subthalamic nucleus electrical activity on the side fi rst operated on, although their monitoring technique was different (not using simultaneous implantations of several parallel electrodes; when the recording obtained was not satisfactory, the electrode was removed and reinserted 2 mm from the initial target) (15).…”

Section: Discussionmentioning

confidence: 95%

Subthalamic electrode implantation using the MicroDrive system and the importance of microrecording data

Chrastina¹,

Novák²,

Baláž³

et al. 2013

BLL

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Abstract:Objective: The aim of the paper was to describe the relationship of the anatomical and electrophysiological target for the subthalamic electrode implantation in Parkinson's disease patients defi ned as the best electrophysiological recordings from multiple paralel electrodes tracts with a target discrepancy explanation. Background: Although microrecording is the standard in subthalamic stimulation, microelectrode monitoring prolongs surgical time and may increase the risk of haemorrhagic complications. The main purpose for the electrophysiological mapping is to overcome the discrepancy between the anatomical and electrophysiological targets. Methods: Subthalamic electrodes were stereotactically implanted in 58 patients using microrecording by means of parallel electrodes at defi ned distances. The relationship of the fi nal electrode to the anatomical trajectory, the subthalamic nucleus electrical activity length, and the relationship of right and left electrodes were analysed. Results: The fi nal electrode placement matched the anatomical trajectory in 53.4 % of patients on the right side, and 43.1 % of patients on the left side. The electrode position was symmetrical in 38.3 % of patients. The analysis of left and right electrode positions did not prove brain shift as the sole factor responsible for anatomyfunctional discrepancy. Further, neither age, Parkinson's disease duration, or L-DOPA adverse effects were confi rmed as responsible factors. Conclusions:The difference between the anatomical trajectory and the fi nal electrode placement underlined the need for functional microelectrode monitoring. Brain shift is not the only causative factor for the difference (Tab. 7, Ref. 27). Full Text in PDF www.elis.sk.

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Targeting the subthalamic nucleus for deep brain stimulation: technical approach and fusion of pre- and postoperative MR images to define accuracy of lead placement

Cited by 128 publications

References 23 publications

Brain shift during bur hole–based procedures using interventional MRI

Brain shift during bur hole–based procedures using interventional MRI

Neuroimaging and Deep Brain Stimulation

Subthalamic electrode implantation using the MicroDrive system and the importance of microrecording data

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