Targeting Accuracy of the Subthalamic Nucleus in Deep Brain Stimulation Surgery: Comparison Between 3 T T2-Weighted Magnetic Resonance Imaging and Microelectrode Recording Results

Nowacki, Andreas; Debove, Ines; Fiechter, Michael; Rossi, Frédéric; Oertel, Markus Florian; Wiest, Roland; Schüpbach, Michaël; Pollo, Claudio

doi:10.1093/ons/opx175

Cited by 20 publications

(17 citation statements)

References 19 publications

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“…From each patient's data set, we concluded that the DBS lead artefact on postoperative CT reflected the actual lead position within the STN reliably as we found no difference between the reconstructed image-based trajectories through the STN and their corresponding electrophysiological activity. This is in line with previous work by our and other groups ( Hamani et al, 2005 ; Kocabicak et al, 2013 ; Nowacki et al, 2017 ; Schlaier et al, 2011 ).…”

Section: Discussionsupporting

confidence: 94%

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Accuracy of different three-dimensional subcortical human brain atlases for DBS –lead localisation

Nowacki

Nguyen

Tinkhauser

et al. 2018

NeuroImage: Clinical

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BackgroundAccurate interindividual comparability of deep brain stimulation (DBS) lead locations in relation to the surrounding anatomical structures is of eminent importance to define and understand effective stimulation areas. The objective of the current work is to compare the accuracy of the DBS lead localisation relative to the STN in native space with four recently developed three-dimensional subcortical brain atlases in the MNI template space. Accuracy is reviewed by anatomical and volumetric analysis as well as intraoperative electrophysiological data.MethodsPostoperative lead localisations of 10 patients (19 hemispheres) were analysed in each individual patient based on Brainlab software (native space) and after normalization into the MNI space and application of 4 different human brain atlases using Lead-DBS toolbox within Matlab (template space). Each patient's STN was manually segmented and the relation between the reconstructed lead and the STN was compared to the 4 atlas-based STN models by applying the Dice coefficient. The length of intraoperative electrophysiological STN activity along different microelectrode recording tracks was measured and compared to reconstructions in native and template space. Descriptive non-parametric statistical tests were used to calculate differences between the 4 different atlases.ResultsThe mean STN volume of the study cohort was 153.3 ± 40.3 mm3 (n = 19). This is similar to the STN volume of the DISTAL atlas (166 mm3; p = .22), but significantly larger compared to the other atlases tested in this study. The anatomical overlap of the lead-STN-reconstruction was highest for the DISTAL atlas (0.56 ± 0.18) and lowest for the PD25 atlas (0.34 ± 0.17). A total number of 47 MER trajectories through the STN were analysed. There was a statistically significant discrepancy of the electrophysiogical STN activity compared to the reconstructed STN of all four atlases (p < .0001).Conclusion: Lead reconstruction after normalization into the MNI template space and application of four different atlases led to different results in terms of the DBS lead position relative to the STN. Based on electrophysiological and imaging data, the DISTAL atlas led to the most accurate display of the reconstructed DBS lead relative to the DISTAL-based STN.

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Section: Discussionsupporting

confidence: 94%

“…For detailed description of our targeting approach and operative procedure we refer to previously published reports of our group ( Nowacki et al, 2017 ). In summary, each patient underwent preoperative MRI to target the STN.…”

Section: Methodsmentioning

confidence: 99%

Accuracy of different three-dimensional subcortical human brain atlases for DBS –lead localisation

Nowacki

Nguyen

Tinkhauser

et al. 2018

NeuroImage: Clinical

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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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“…12,31 MER may have its advantages in identifying the electrophysiologic footprint of some target structures 11 that can differ from the MRI-derived target boundaries and can be performed under general anesthesia or dopaminergic medication. 24,32,33 The widespread rates of MER-based adjustments in the literature may be explained by the variable a priori use of single or multiple microelectrodes. 11 Often, more than one, for example, two to three microelectrodes are used in a classical neurophysiologic mapping approach.…”

Section: Intraoperative Neurophysiologic Recordingmentioning

confidence: 99%

Intraoperative Neurophysiologic Assessment in Deep Brain Stimulation Surgery and its Impact on Lead Placement

Krauss

Oertel

Baumann‐Vogel

et al. 2020

J Neurol Surg A Cent Eur Neurosurg

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Objectives While the efficacy of deep brain stimulation (DBS) to treat various neurological disorders is undisputed, the surgical methods differ widely and the importance of intraoperative microelectrode recording (MER) or macrostimulation (MS) remains controversially debated. The objective of this study is to evaluate the impact of MER and MS on intraoperative lead placement. Patients and Methods We included 101 patients who underwent awake bilateral implantation of electrodes in the subthalamic nucleus with MER and MS for Parkinson's disease from 2009 to 2017 in a retrospective observational study. We analyzed intraoperative motor outcomes between anatomically planned stimulation point (PSP) and definite stimulation point (DSP), lead adjustments and Unified Parkinson's Disease Rating Scale Item III (UPDRS-III), levodopa equivalent daily dose (LEDD), and adverse events (AE) after 6 months. Results We adjusted 65/202 leads in 47/101 patients. In adjusted leads, MS results improved significantly when comparing PSP and DSP (p < 0.001), resulting in a number needed to treat of 9.6. After DBS, UPDRS-III and LEDD improved significantly after 6 months in adjusted and nonadjusted patients (p < 0.001). In 87% of leads, the active contact at 6 months still covered the optimal stimulation point during surgery. In total, 15 AE occurred. Conclusion MER and MS have a relevant impact on the intraoperative decision of final lead placement and prevent from a substantial rate of poor stimulation outcome. The optimal stimulation points during surgery and chronic stimulation strongly overlap. Follow-up UPDRS-III results, LEDD reductions, and DBS-related AE correspond well to previously published data.

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Targeting Accuracy of the Subthalamic Nucleus in Deep Brain Stimulation Surgery: Comparison Between 3 T T2-Weighted Magnetic Resonance Imaging and Microelectrode Recording Results

Abstract: STN MRI-based targeting is accurate in the majority of cases on the first and second side of surgery. In 43% of implanted electrodes, we found a relevant deviation of more than 1 mm, supporting the concept of MER as an important tool to guide and optimize targeting and electrode placement.

Cited by 20 publications

References 19 publications

Accuracy of different three-dimensional subcortical human brain atlases for DBS –lead localisation

Accuracy of different three-dimensional subcortical human brain atlases for DBS –lead localisation

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

Intraoperative Neurophysiologic Assessment in Deep Brain Stimulation Surgery and its Impact on Lead Placement

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