MRI- and skull x-ray-based approaches to evaluate the position of deep brain stimulation electrode contacts - a technical note

Abstract

Deep brain stimulation (DBS) has developed into an established therapy for the treatment of movement disorders, most commonly Parkinson's disease and tremor of different etiology. The subthalamic nucleus (STN) has evolved as the preferred target for DBS in patients with idiopathic Parkinson's disease. The principal target for DBS in tremor patients is the ventrolateral thalamus which has been explored for ablative procedures (thalamotomy) for some decades. Detailed information about the exact site of chronic stimulation, i.e. the location of the active electrode contacts, are important to map the actual subcortical structures modulating the therapeutic effects of DBS. We compared two different methods not requiring intra-operative teleradiography to determine the stereotactic coordinates of single electrode contacts, (i) correlation of pre- and post-operative MRI, and (ii) post-operative stereotactic skull x-ray. For seven patients implanted bilateral with quadripolar DBS electrodes the coordinates for each contact were determined by both approaches. This revealed for a total of 56 electrode contacts a median euclidean 3D-difference between both methods of 1.18 mm (range 0.42 to 1.93 mm). These data suggest that both approaches may be used to determine the position of single electrode contacts.

Zusammenfassung

Die Tiefenhirnstimulation hat sich als Therapieverfahren zur Behandlung von Bewegungsstörungen, insbesondere des idiopathischen Morbus Parkinson und ätiologisch unterschiedlicher Tremorerkrankungen durchgesetzt. Der Nucleus subthalamicus ist der bevorzugte Zielpunkt zur Behandlung des M. Parkinson. Die primäre Zielstruktur zur Tremorbehandlung durch Tiefenhirnstimulation ist der ventrolaterale Thalamus, der bereits seit Jahrzehnten im Rahmen ablativer Operationsverfahren (Thalamotomie) exploriert wird. Detaillierte Angaben über den genauen Stimulationsort, d.h. die Position des aktiven Elektrodenkontakts, sind von großer Bedeutung, um die wesentlichen subkortikalen Strukturen einzugrenzen, die für den therapeutischen Effekt der Tiefenhirnstimulation eine Rolle spielen. Wir haben zwei Methoden, die unabhängig von der Verfügbarkeit einer Teleradiographieanlage durchgeführt werden können und zur Bestimmung stereotaktischer Koordinaten einzelner Elektrodenkontakte geeignet sind, miteinander verglichen. Diese beruhen auf (i) der Korrelation prä- und postoperativer Kernspintomographien und (ii) postoperativen stereotaktischen Röntgenaufnahmen des Schädels. Von sieben Patienten mit bilateralen quadripolaren Stimulationselektroden wurden die Koordinaten jedes Elektrodenkontakts durch beide Methoden bestimmt. Dies ergab eine mediane, räumliche Abweichung von 1,18 mm (Minimum 0,42 mm, Maximum 1,93 mm) zwischen beiden Methoden für insgesamt 56 untersuchte Elektrodenkontakte. Demnach eignen sind beide Methoden zur postoperativen Positionsbestimmung einzelner Elektrodenkontakte.

Key words:

Deep brain stimulation - MRI - Electrode contact - Parkinson's disease - Essential tremor

Schlüsselwörter:

Tiefenhirnstimulation - Kernspintomographie - Elektrodenkontakt - Morbus Parkinson - Essentieller Tremor

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