Comparison of Anatomic and Neurophysiological Methods for Subthalamic Nucleus Targeting

Zonenshayn, Martin; Rezai, Ali R.; Mogilner, Alon Y.; Berić, Aleksandar; Sterio, Djordje; Kelly, Patrick J.

doi:10.1097/00006123-200008000-00005

Cited by 190 publications

(149 citation statements)

References 45 publications

Supporting

Mentioning

115

Contrasting

Unclassified

Order By: Relevance

“…Past studies comparing 3D mapping of the target and direct MR guided planning showed an inferior accuracy of MR guided planning (6). The progress in MR imaging, better protocols with a superior resolution, and elimination of distortion results in more centres inclining to MR guided planning, sometimes without a microelectrode recording and using one track (7,8,9).…”

Section: Discussionmentioning

confidence: 99%

Prevalent placement error of deep brain stimulation electrode in movement disorders (technical considerations)

Kloc¹,

Košutzká²,

Štěňo³

et al. 2017

BLL

View full text Add to dashboard Cite

BACKGROUND: Deep brain stimulation is an effective and safe technique. Displacement of the electrode relative to the optimal stimulation site can lead to insuffi cient effect and sometimes to the need of operative electrode re-position. OBJECTIVE: This study was aimed to analyse targeting accuracy of deep brain stimulation electrode implantation to subthalamic nucleus (STN) and globus pallidus internus (Gpi). It detected possible causes of inaccuracy and prevalent shift to certain direction. METHODS: Targeting accuracy was analysed in 47 patients with Parkinson´s disease (PD) and 11 patients with dystonia with bilateral implantation of deep brain stimulation electrodes between years 2009 and 2016. RESULTS: A shift of electrode to prevalent direction was observed on the left side to medial and posterior and on the right side to lateral direction. Greater shift was observed on the left side and in a higher angulation of trajectory laterally. Movement of the electrode, because of its traction in anchoring device, was identifi ed as a possible factor for prevalent electrode shift. Calibration of stereotactic coordinates to correct prevalent shift was used. CONCLUSION: Targeting inaccuracy is the result of accumulation of errors in individual steps of electrode implantation. Direction of the shift can be random or it can be toward a prevalent direction. A correction of prevalent error can prevent a suboptimal electrode placement (Tab. 3, Fig. 11, Ref. 29). Text in PDF www.elis.sk.

show abstract

Section: Discussionmentioning

confidence: 99%

Prevalent placement error of deep brain stimulation electrode in movement disorders (technical considerations)

Kloc¹,

Košutzká²,

Štěňo³

et al. 2017

BLL

View full text Add to dashboard Cite

show abstract

“…Bejjani et al reported that MRI alone was not sufficient in their experience of 12 cases in which T2-weighted coronal images were used for targeting 1) . Zonenshayn and colleagues found that MRI targeting was the least accurate method with an average error of 2.6 mm 38) . Our experience supports their findings.…”

Section: Discussionmentioning

confidence: 99%

STN DBS of Advanced Parkinson's Disease Experienced in a Specialized Monitoring Unit with a Prospective Protocol

Lee

Han

Kim

et al. 2008

J Korean Neurosurg Soc

View full text Add to dashboard Cite

“…Other groups provided data showing image distortion and low resolution may make direct targeting using T2WI alone problematic. 2,59 Others have shown good clinical results using this sequence while scanning a patient who is anesthetized and undergoing direct anatomical surgical techniques. 38 Distortion remains one of the most significant challenges in MRI imaging of the STN.…”

Section: Spin Echo Techniquesmentioning

confidence: 98%

“…MRI distortion alone in T2 fast SE (FSE) sequences has been shown to cause a total error of up to 2.4 mm, limiting the accuracy of MRI in targeting very small structures. 59 These distortions have been noticed particularly at the peripheries of the target structures, obscuring tissue borders. 34 This distortion appears to be amplified when using T2 FSE sequences in combination with a stereotactic head frame; however, more recent studies have suggested that this distortion may not be as significant as hypothesized.…”

Section: Spin Echo Techniquesmentioning

confidence: 99%

Magnetic resonance imaging of the subthalamic nucleus for deep brain stimulation

Chandran¹,

Bynevelt

Lind

2016

JNS

View full text Add to dashboard Cite

F uture progress to refine targets for deep brain stimulation (DBS) is critically dependent on precise placement and verification of electrodes in the brain. No stereotactic target is of more clinical importance or more nuanced regarding its imaging than the subthalamic nucleus (STN). The STN is difficult to image because of its biconvex shape, small size, oblique spatial orientation in 3 planes, and its close proximity to the substantia nigra (SN).3 A high level of accuracy is required as the motor region of the STN is posterolateral, and unwanted stimulation side effects may occur as a result of direct stimulation or spread to the anteromedial nonmotor area and the adjacent corticospinal tract. 9,18,31,56 Current imaging of STN borders is difficult.Targeting of the STN has historically been performed indirectly; the neurosurgeon predicts the location of the STN based on coordinates derived from atlases. These coordinates have often been related to the midcommissural point, which was derived from x-ray ventriculography but also from CT and MRI. Retaining this indirect, coordinate-based approach has been attractive to neurosurgeons. Experience in using this approach has been handed down from the past and can be used even with modern noninvasive imaging, and targeting preferences can be easily communicated between surgeons. The problem with indirect targeting is that different patients have different STN sizes, shapes, and positions.38 Direct targeting is an attempt to locate the STN in each individual patient.Poor image quality on traditional 1.5 tesla (T) scanners and primitive pulse sequences that do not provide adequate contrast at the level of the STN have limited the progression of direct targeting in some centers. Also hindering the development of stereotactic MRI are concerns about image distortion with higher field strength; traditional stereotactic head frames and localizers are too bulky to permit the use of high-quality, multichannel MRI head coils.Despite these challenges, higher field strength scanners and new pulse sequences have improved image quality to a point that some groups have adopted direct targeting of the STN, based on MRI.3,9,37 Difficulty delineating the STN and spatial inaccuracy has resulted in reluctance from others to abandon adjuncts such as CT/MRI merge and intraoperative electrophysiology.Traditionally, T2-weighted imaging (T2WI) has been used to plan for direct targeting of the STN using a variety of imaging parameters (Fig. 1).9 Although T2WI is useful, it is difficult to clearly delineate the STN from the SN and, to a lesser extent, the zona incerta (ZI). 22,32,37 abbreviatioNs CNR = contrast-to-noise ratio; DBS = deep brain stimulation; DTI = diffusion tensor imaging; FA = fractional anisotropy; FGATIR = fast gray matter acquisition T1 IR; FLAIR = fluid attenuated IR; FLASH = fast low-angle shot; FSE = fast spin echo; GRE = gradient echo; IR = inversion recovery; NSA = number of signal averages; PSIR = phase-sensitive IR; QSM = quantitative susceptibility mapping; SE = spin ...

show abstract

Comparison of Anatomic and Neurophysiological Methods for Subthalamic Nucleus Targeting

Abstract: Although all anatomic targeting methods provide accurate STN localization, a combination of the three methods offers the best correlation with the final physiological target. In our experience, direct magnetic resonance targeting was the least accurate method.

Cited by 190 publications

References 45 publications

Prevalent placement error of deep brain stimulation electrode in movement disorders (technical considerations)

Prevalent placement error of deep brain stimulation electrode in movement disorders (technical considerations)

STN DBS of Advanced Parkinson's Disease Experienced in a Specialized Monitoring Unit with a Prospective Protocol

Magnetic resonance imaging of the subthalamic nucleus for deep brain stimulation

Contact Info

Product

Resources

About