Subscribe to RSS
DOI: 10.1055/s-0040-1715826
The Accuracy of Direct Targeting Using Fusion of MR and CT Imaging for Deep Brain Stimulation of the Subthalamic Nucleus in Patients with Parkinson's Disease
![](https://www.thieme-connect.de/media/jnlsa/202106/lookinside/thumbnails/10-1055-s-0040-1715826_192499oa-1.jpg)
Abstract
Introduction In 33 consecutive patients with Parkinson's disease (PD) undergoing awake deep brain stimulation (DBS) without microelectrode recording (MER), we assessed and validated the precision and accuracy of direct targeting of the subthalamic nucleus (STN) using preoperative magnetic resonance imaging (MRI) and stereotactic computed tomography (CT) image fusion combined with immediate postoperative stereotactic CT and postoperative MRI, and we report on the side effects and clinical results up to 6 months' follow-up.
Materials and Methods Preoperative nonstereotactic MRI and stereotactic CT images were merged and used for planning the trajectory and final lead position. Immediate postoperative stereotactic CT and postoperative nonstereotactic MRI provided the validation of the final electrode position. Changes in the Unified Parkinson's Disease Rating Scale III (UPDRS III) scores and the levodopa equivalent daily doses (LEDD) and appearance of adverse side effects were assessed.
Results The mean Euclidian distance (ED) error between the planned position and the final position of the lead in the left STN was 1.69 ± 0.82 mm and that in the right STN was 2.12 ± 1.00. The individual differences between planned and final position in each of the three coordinates were less than 2 mm. The UPDRS III scores improved by 75% and LEDD decreased by 45%. Few patients experienced complications, such as postoperative infection (n = 1), or unwanted side effects, such as emotional instability (n = 1).
Conclusion Our results confirm that direct targeting of an STN on stereotactic CT merged with MRI could be a valid method for placement the DBS electrode. The magnitude of our targeting error is comparable with the reported errors when using MER and other direct targeting approaches.
Financial Disclosures
This research was supported by Croatian Science Foundation grant no. UIP-2017–05–7578 (G.S.). This publication was cofinanced by the European Union through the European Regional Development Fund, Operational Program Competitiveness and Cohesion, grant agreement no. KK.01.1.1.01.0007, CoRE - Neuro.
Publication History
Received: 26 July 2019
Accepted: 13 February 2020
Article published online:
22 February 2021
© 2021. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
-
References
- 1 Benabid AL, Chabardes S, Mitrofanis J, Pollak P. Deep brain stimulation of the subthalamic nucleus for the treatment of Parkinson's disease. Lancet Neurol 2009; 8 (01) 67-81
- 2 Starr PA, Christine CW, Theodosopoulos PV. et al. Implantation of deep brain stimulators into the subthalamic nucleus: technical approach and magnetic resonance imaging-verified lead locations. J Neurosurg 2002; 97 (02) 370-387
- 3 McClelland III S, Kim B, Winfield LM. et al. Microelectrode recording-determined subthalamic nucleus length not predictive of stimulation-induced side effects. Neurosurg Focus 2005; 19 (05) E13
- 4 Bus S, van den Munckhof P, Bot M. et al. Borders of STN determined by MRI versus the electrophysiological STN. A comparison using intraoperative CT. Acta Neurochir (Wien) 2018; 160 (02) 373-383
- 5 Lee PS, Weiner GM, Corson D. et al. Outcomes of interventional-MRI versus microelectrode recording-guided subthalamic deep brain stimulation. Front Neurol 2018; 9: 241
- 6 Patel NK, Heywood P, O'Sullivan K, Love S, Gill SS. MRI-directed subthalamic nucleus surgery for Parkinson's disease. Stereotact Funct Neurosurg 2002; 78 (3-4): 132-145
- 7 Starr PA, Martin AJ, Ostrem JL, Talke P, Levesque N, Larson PS. Subthalamic nucleus deep brain stimulator placement using high-field interventional magnetic resonance imaging and a skull-mounted aiming device: technique and application accuracy. J Neurosurg 2010; 112 (03) 479-490
- 8 Matias CM, Frizon LA, Nagel SJ, Lobel DA, Machado AG. Deep brain stimulation outcomes in patients implanted under general anesthesia with frame-based stereotaxy and intraoperative MRI. J Neurosurg 2018; 129 (06) 1572-1578
- 9 Burchiel KJ, McCartney S, Lee A, Raslan AM. Accuracy of deep brain stimulation electrode placement using intraoperative computed tomography without microelectrode recording. J Neurosurg 2013; 119 (02) 301-306
- 10 Lee PS, Richardson RM. Interventional MRI-guided deep brain stimulation lead implantation. Neurosurg Clin N Am 2017; 28 (04) 535-544
- 11 Obeso JA, Olanow CW, Rodriguez-Oroz MC, Krack P, Kumar R, Lang AE. ; Deep-Brain Stimulation for Parkinson's Disease Study Group. Deep-brain stimulation of the subthalamic nucleus or the pars interna of the globus pallidus in Parkinson's disease. N Engl J Med 2001; 345 (13) 956-963
- 12 Hariz M. My 25 Stimulating years with DBS in Parkinson's disease. J Parkinsons Dis 2017; 7 (Suppl. 01) S33-S41
- 13 Zrinzo L, Foltynie T, Limousin P, Hariz MI. Reducing hemorrhagic complications in functional neurosurgery: a large case series and systematic literature review. J Neurosurg 2012; 116 (01) 84-94
- 14 Machado A, Rezai AR, Kopell BH, Gross RE, Sharan AD, Benabid AL. Deep brain stimulation for Parkinson's disease: surgical technique and perioperative management. Mov Disord 2006; 21 (Suppl. 14) S247-S258
- 15 Ashkan K, Blomstedt P, Zrinzo L. et al. Variability of the subthalamic nucleus: the case for direct MRI guided targeting. Br J Neurosurg 2007; 21 (02) 197-200
- 16 Park SC, Lee CS, Kim SM, Choi EJ, Lee JK. Comparison of the stereotactic accuracies of function-guided deep brain stimulation, calculated using multitrack target locations geometrically inferred from three-dimensional trajectory rotations, and of magnetic resonance imaging-guided deep brain stimulation and outcomes. World Neurosurg 2017; 98: 734-749.e7
- 17 Liu X, Zhang J, Fu K, Gong R, Chen J, Zhang J. Microelectrode recording-guided versus intraoperative magnetic resonance imaging-guided subthalamic nucleus deep brain stimulation surgery for Parkinson disease: a 1-year follow-up study. World Neurosurg 2017; 107: 900-905
- 18 Pollo C, Meuli R, Maeder P, Vingerhoets F, Ghika J, Villemure JG. Subthalamic nucleus deep brain stimulation for Parkinson's disease: magnetic resonance imaging targeting using visible anatomical landmarks. Stereotact Funct Neurosurg 2003; 80 (1–4): 76-81
- 19 Petersen EA, Holl EM, Martinez-Torres I. et al. Minimizing brain shift in stereotactic functional neurosurgery. Neurosurgery 2010;67(03), Suppl Operative ):ons213–ons221, discussion ons221
- 20 Carlson JD, McLeod KE, McLeod PS, Mark JB. Stereotactic accuracy and surgical utility of the O-arm in deep brain stimulation surgery. Oper Neurosurg (Hagerstown) 2017; 13 (01) 96-107
- 21 Frizon LA, Shao J, Maldonado-Naranjo AL. et al. The safety and efficacy of using the O-arm intraoperative imaging system for deep brain stimulation lead implantation. Neuromodulation 2018; 21 (06) 588-592
- 22 Hamel W, Köppen JA, Alesch F. et al. Targeting of the subthalamic nucleus for deep brain stimulation: a survey among Parkinson disease specialists. World Neurosurg 2017; 99: 41-46
- 23 Shahlaie K, Larson PS, Starr PA. Intraoperative computed tomography for deep brain stimulation surgery: technique and accuracy assessment. Neurosurgery 2011;68(01), Suppl Operative ):114–124, discussion 124
- 24 Bot M, van den Munckhof P, Bakay R, Stebbins G, Verhagen Metman L. Accuracy of intraoperative computed tomography during deep brain stimulation procedures: comparison with postoperative magnetic resonance imaging. Stereotact Funct Neurosurg 2017; 95 (03) 183-188
- 25 Steel DA, Basu S. Does trajectory matter? A study looking into the relationship of trajectory with target engagement and error accommodation in subthalamic nucleus deep brain stimulation. Acta Neurochir (Wien) 2017; 159 (07) 1335-1340
- 26 Temel Y, Wilbrink P, Duits A. et al. Single electrode and multiple electrode guided electrical stimulation of the subthalamic nucleus in advanced Parkinson's disease. Neurosurgery 2007;61(05, Suppl 2):346–355, discussion 355–357
- 27 Chang WS, Kim HY, Kim JP, Park YS, Chung SS, Chang JW. Bilateral subthalamic deep brain stimulation using single track microelectrode recording. Acta Neurochir (Wien) 2011; 153 (05) 1087-1095
- 28 Umemura A, Oka Y, Yamada K, Oyama G, Shimo Y, Hattori N. Validity of single tract microelectrode recording in subthalamic nucleus stimulation. Neurol Med Chir (Tokyo) 2013; 53 (11) 821-827
- 29 Saleh S, Swanson KI, Lake WB, Sillay KA. Awake neurophysiologically guided versus asleep MRI-guided STN DBS for Parkinson disease: a comparison of outcomes using levodopa equivalents. Stereotact Funct Neurosurg 2015; 93 (06) 419-426
- 30 Slavin KV, Thulborn KR, Wess C, Nersesyan H. Direct visualization of the human subthalamic nucleus with 3T MR imaging. AJNR Am J Neuroradiol 2006; 27 (01) 80-84
- 31 Polanski WH, Martin KD, Engellandt K. et al. Accuracy of subthalamic nucleus targeting by T2, FLAIR and SWI-3-Tesla MRI confirmed by microelectrode recordings. Acta Neurochir (Wien) 2015; 157 (03) 479-486