Deep brain stimulation of the subthalamic nucleus: histological verification and 9.4-T MRI correlation

Al-Helli, O.; Thomas, David L.; Massey, Luke A.; Foltynie, Thomas; Limousin, Patricia; Holton, Janice L.; Yousry, Tarek; Zrinzo, Ludvic

doi:10.1007/s00701-015-2599-x

Cited by 12 publications

(13 citation statements)

References 17 publications

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“…7 Although evidence supports this method of STN-DBS in improving the motor symptoms of those with PD, it is noted that on rare occasions (owing to anatomical variations in brain structure), the use of the central tract may lead to detrimental effects, thus necessitating its omission when performing this procedure. 8,9 In this present study sample, it was found that the central tract is only used as the final lead placement in 63.83% of reported cases, which is significantly less than previously reported literature. This therefore emphasises the importance of accurate preoperative and intraoperative planning and microelectrode testing, in conjunction with awake macro-stimulation, to assess real-time clinical response.…”

Section: Discussioncontrasting

confidence: 56%

Deep brain stimulation in Parkinson's disease: analysis of the variation in final stimulating lead placement based on multi-tract electrode recordings

Jacobs

Melvill²

2018

S. Afr. j. surg.

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Background: Deep brain stimulation (DBS) of the subthalamic nucleus (SNT) is a treatment modality for Parkinson's Disease (PD). Either single central trajectory tract or multiple selected trajectory tracts based on microelectrode recordings (MER) are used for the placement of the final stimulating electrodes. This study aims to explore how many times trajectory tracts, other than the central tract are used for final lead placement. Methods: Retrospective analysis of a randomly selected convenience sample of 24 subjects from patients who had DBS by a single neurosurgeon. After MRI and CT assessment, planning using a stereotactic frame for variable trajectory placement of temporary electrodes and MER that was the basis for site and tract selection for the final electrode placements used for DBS. Results: Twenty four patients had 47 DBS electrodes placed: 1 unilateral and 23 bilateral. The central tract was used in 45 (95.75%) of these cases. The central trajectory tract accounted for 30 (63.83%), the anterior trajectory tract for 7 (14.89%), the medial tract for 5 (10.64%), the posterior for 4 (8.51%) and the lateral for 1 (2.13%) of final lead placements. Conclusion: The results of this study based on the predicted best stimulating sites following MER show that alternates to the central trajectory tract are required in 37% of site placements. A comparative study exploring clinical benefit is required to assess if variable electrode trajectory placement based on accurate physiological measurements is superior to single central trajectory placement.

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Section: Discussioncontrasting

confidence: 56%

Deep brain stimulation in Parkinson's disease: analysis of the variation in final stimulating lead placement based on multi-tract electrode recordings

Jacobs

Melvill²

2018

S. Afr. j. surg.

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“…Sections of 20 µm were obtained using a sliding microtome (Histoslide 2000R, Leica, Nussloch, Germany) similar to the study of Al‐Helli and coworkers [Al‐Helli et al, ]. The specimens were cut axially.…”

Section: Methodsmentioning

confidence: 99%

“…These blocks were treated in the same manner as the midbrain specimens. Volumes were determined before dehydrating the specimens in ethanol as well as after incubation in paraffin wax, measuring Sections of 20 mm were obtained using a sliding microtome (Histoslide 2000R, Leica, Nussloch, Germany) similar to the study of Al-Helli and coworkers [Al-Helli et al, 2015]. The specimens were cut axially.…”

Section: Histologymentioning

confidence: 99%

Subthalamic nucleus volumes are highly consistent but decrease age-dependently-a combined magnetic resonance imaging and stereology approach in humans

et al. 2016

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The subthalamic nucleus (STN) is a main target structure of deep brain stimulation (DBS) in idiopathic Parkinson's disease. Nevertheless, there is an ongoing discussion regarding human STN volumes and neuron count, which could potentially have an impact on STN-DBS. Moreover, a suspected functional subdivision forms the basis of the tripartite hypothesis, which has not yet been morphologically substantiated. In this study, it was aimed to investigate the human STN by means of combined magnetic resonance imaging (MRI) and stereology. STN volumes were obtained from 14 individuals (ranging from 65 to 96 years, 25 hemispheres) in 3 T MRI and in luxol-stained histology slices. Neuron number and cell densities were investigated stereologically over the entire STN and in pre-defined subregions in anti-human neuronal protein HuC/D-stained slices. STN volumes measured with MRI were smaller than in stereology but appeared to be highly consistent, measuring on average 99 ± 6 mm (MRI) and 132 ± 20 mm (stereology). The neuron count was 431,088 ± 72,172. Both STN volumes and cell count decreased age-dependently. Neuron density was different for the dorsal, medial and ventral subregion with significantly higher values ventrally than dorsally. Small variations in STN volumes in both MRI and stereology contradict previous findings of large variations in STN size. Age-dependent decreases in STN volumes and neuron numbers might influence the efficacy of STN-DBS in a geriatric population. Though the study is limited in sample size, site-dependent differences for the STN subregions form a morphological basis for the tripartite theory. Hum Brain Mapp 38:909-922, 2017. © 2016 Wiley Periodicals, Inc.

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“…Although our reconstruction is principled and preliminary results show correspondence with the clinical standard-of-care, there is no “gold standard” (other than postmortem histology) for verifying these results [14–16]. In addition, our intrapatient linear registration methods did not take pneumocephalus-related intraoperative brain shift into account.…”

Section: Discussionmentioning

confidence: 98%

DBStar: An Open-Source Tool Kit for Imaging Analysis with Patient-Customized Deep Brain Stimulation Platforms

Lauro¹,

Lee²,

Ahn³

et al. 2018

Stereotact Funct Neurosurg

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Background/Objectives: To create an open-source method for reconstructing microelectrode recording (MER) and deep brain stimulation (DBS) electrode coordinates along multiple parallel trajectories with patient-specific DBS implantation platforms to facilitate DBS research. Methods: We combined the surgical geometry (extracted from WayPoint Planner), pre-/intra-/postoperative computed tomography (CT) and/or magnetic resonance (MR) images, and integrated them into the Analysis of Functional NeuroImages (AFNI) neuroimaging analysis environment using functions written in Python. Electrode coordinates were calculated from image-based electrode surfaces and recording trajectory depth values. Coordinates were translated into appropriate trajectories, and were tested for proximity to patient-specific or atlas-based anatomical structures. Final DBS electrode coordinates for 3 patient populations (ventral intermediate nucleus [VIM], subthalamic nucleus [STN], and globus pallidus pars interna [GPi]) were calculated. For STN cases, MER site coordinates were then analyzed to see whether they were inside or outside the STN. Results: Final DBS electrode coordinates were described for VIM, STN, and GPi patient populations. 115/169 (68%) STN MER sites were within 1 mm of the STN in AFNI’s Talairach and Tournoux (TT) atlas. Conclusions: DBStar is a robust tool kit for understanding the anatomical location and context of electrode locations, and can easily be used for imaging, behavioral, or electrophysiological analyses.

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Deep brain stimulation of the subthalamic nucleus: histological verification and 9.4-T MRI correlation

Abstract: This study supports the anatomical accuracy of the MRI-guided and MRI-verified method of STN DBS.

Cited by 12 publications

References 17 publications

Deep brain stimulation in Parkinson's disease: analysis of the variation in final stimulating lead placement based on multi-tract electrode recordings

Deep brain stimulation in Parkinson's disease: analysis of the variation in final stimulating lead placement based on multi-tract electrode recordings

Subthalamic nucleus volumes are highly consistent but decrease age-dependently-a combined magnetic resonance imaging and stereology approach in humans

DBStar: An Open-Source Tool Kit for Imaging Analysis with Patient-Customized Deep Brain Stimulation Platforms

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