Borders of STN determined by MRI versus the electrophysiological STN. A comparison using intraoperative CT

Bus, Sander; Munckhof, Pepijn van den; Bot, Maarten; Pal, Gian; Ouyang, Bo; Sani, Sepehr; Metman, Leo Verhagen

doi:10.1007/s00701-017-3432-5

Cited by 23 publications

(22 citation statements)

References 39 publications

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“…One study showed that the final stimulation site, based on MER and intraoperative stimulation, was located more lateral and superior than both atlas and MRI based targets . Also, newer studies show discrepancies comparing borders on T2 and SWI MRI sequences compared to the electrophysiological STN . Further research is needed to evaluate the impact of these newer techniques on target accuracy and clinical outcome …”

Section: Discussionmentioning

confidence: 99%

Multiple Microelectrode Recordings in STN‐DBS Surgery for Parkinson's Disease: A Randomized Study

Bjerknes

Toft

Konglund

et al. 2018

Movement Disord Clin Pract

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BackgroundSubthalamic nucleus deep brain stimulation improves motor symptoms and fluctuations in advanced Parkinson's disease, but the degree of clinical improvement depends on accurate anatomical electrode placement. Methods used to localize the sensory‐motor part of the nucleus vary substantially. Using microelectrode recordings, at least three inserted microelectrodes are needed to obtain a three‐dimensional map. Therefore, multiple simultaneously inserted microelectrodes should provide better guidance than single sequential microelectrodes. We aimed to compare the use of multiple simultaneous versus single sequential microelectrode recordings on efficacy and safety of subthalamic nucleus stimulation.MethodsSixty patients were included in this double‐blind, randomized study, 30 in each group. Primary outcome measures were the difference from baseline to 12 months in the MDS‐UPDRS motor score (part III) in the off‐medication state and quality of life using the Parkinson's Disease Questionnaire‐39 (PDQ‐39) scores.ResultsThe mean reduction of the MDS‐UPDRS III off score was 35 (SD 12) in the group investigated with multiple simultaneous microelectrodes compared to 26 (SD 10) in the single sequential microelectrode group (p = 0.004). The PDQ‐39 Summary Index did not differ between the groups, but the domain scores activities of daily living and bodily discomfort improved significantly more in the multiple microelectrodes group. The frequency of serious adverse events did not differ significantly.ConclusionsAfter 12 months of subthalamic nucleus stimulation, the multiple microelectrodes group had a significantly greater improvement both in MDS‐UPDRS III off score and in two PDQ‐39 domains. Our results may support the use of multiple simultaneous microelectrode recordings.Trial registration http://ClinicalTrials.gov Identifier: NCT00855621 (first received March 3, 2009).

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Section: Discussionmentioning

confidence: 99%

Multiple Microelectrode Recordings in STN‐DBS Surgery for Parkinson's Disease: A Randomized Study

Bjerknes

Toft

Konglund

et al. 2018

Movement Disord Clin Pract

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“…Improvements can refer to a smaller deviation between planned and actual lead location, a reduction in reimplantation or removal requirements, increased clinical efficacy, or decrease in associated side effects. However, the use of T2* contrasts and UHF-MRI remains widely debated and requires further validation [ 37 , 70 , 144 , 148 , 149 , 150 ].…”

Section: Sequence Types and Contrastsmentioning

confidence: 99%

“…Clinical T2w images often incorporate anisotropic voxel sizes with large slice thickness in the z direction. This allows for higher in-plane resolution along the axial plane, which is primarily used for targeting ( Figure 3 ) [ 145 , 149 ]. Voxel sizes will typically range between 0.45 × 0.45 × 2 mm and 1 × 1 × 3 mm.…”

Section: Voxel Sizesmentioning

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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“…However, clinical outcome after STN DBS varies widely between patients [2][3][4][5]. In part, this may be explained by individual anatomical variability of the STN combined with poor visualization of the dorsolateral sensorimotor part of the STN with current imaging techniques [6,7].…”

Section: Introductionmentioning

confidence: 99%

“…As susceptibility-weighted imaging (SWI) gained interest in DBS surgery for PD due to its better visualization of the STN compared to T2-weighted imaging, discrepancies between T2-weighted imaging and SWI have been a subject of study [6,7,15,16]. In localizing the medial STN border, the correspondence between T2-weighted imaging and SWI remains unclear.…”

Section: Introductionmentioning

confidence: 99%

The Medial Subthalamic Nucleus Border as a New Anatomical Reference in Stereotactic Neurosurgery for Parkinson’s Disease

Bolier

Bot

Munckhof

et al. 2020

Stereotact Funct Neurosurg

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Introduction: The intersection of Bejjani’s line with the well-delineated medial subthalamic nucleus (STN) border on MRI has recently been proposed as an individualized reference in subthalamic deep brain stimulation (DBS) surgery for Parkinson’s disease (PD). We, therefore, aimed to investigate the applicability across centers of the medial STN border as a patient-specific reference point in STN DBS for PD and explore anatomical variability between left and right mesencephalic area within patients. Furthermore, we aim to evaluate a recently defined theoretic stimulation “hotspot” in a different center. Methods: Preoperative 3-Tesla T2 and susceptibility-weighted images (SWI) were used to identify the intersection of Bejjani’s line with the medial STN border in left and right mesencephalic area. The average stereotactic coordinates of the center of stimulation relative to the medial STN border were compared with the predefined theoretic stimulation “hotspot.” Results: Fifty-four patients provided 108 stereotactic coordinates of medial STN borders on both sequences. Significant difference in means was found in the Y-(anteroposterior) and Z-(dorsoventral) directions (T2 vs. SWI; p < 0.001). Mean coordinates in the Y-(anteroposterior) direction differed significantly between left and right mesencephalic area (T2: p < 0.001; SWI: p = 0.021). Sixty-six DBS leads were placed in 36 patients that had finished stimulation programming, and the average stereotactic coordinates of the center of stimulation relative to the medial STN border on T2 sequences were 3.1 mm lateral, 0.7 mm anterior, and 1.8 mm superior, in proximity of the predefined theoretic stimulation “hotspot.” Conclusion: The medial STN border is applicable across centers as a reference point for STN DBS surgery for PD and seems suitable in order to account for interindividual and intraindividual anatomical variability if one is aware of the discrepancies between T2-weighted imaging and SWI.

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Borders of STN determined by MRI versus the electrophysiological STN. A comparison using intraoperative CT

Cited by 23 publications

References 39 publications

Multiple Microelectrode Recordings in STN‐DBS Surgery for Parkinson's Disease: A Randomized Study

Multiple Microelectrode Recordings in STN‐DBS Surgery for Parkinson's Disease: A Randomized Study

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

The Medial Subthalamic Nucleus Border as a New Anatomical Reference in Stereotactic Neurosurgery for Parkinson’s Disease

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