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Chauvin RJ, Newbold DJ, Nielsen AN, Miller RL, Krimmel SR, Metoki A, Wang A, Van AN, Montez DF, Marek S, Suljic V, Baden NJ, Ramirez-Perez N, Scheidter KM, Monk JS, Whiting FI, Adeyemo B, Snyder AZ, Kay BP, Raichle ME, Laumann TO, Gordon EM, Dosenbach NU. Disuse-driven plasticity in the human thalamus and putamen. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2023.11.07.566031. [PMID: 37987000 PMCID: PMC10659348 DOI: 10.1101/2023.11.07.566031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
Motor adaptation in cortico-striato-thalamo-cortical loops has been studied mainly in animals using invasive electrophysiology. Here, we leverage functional neuroimaging in humans to study motor circuit plasticity in the human subcortex. We employed an experimental paradigm that combined two weeks of upper-extremity immobilization with daily resting-state and motor task fMRI before, during, and after the casting period. We previously showed that limb disuse leads to decreased functional connectivity (FC) of the contralateral somatomotor cortex (SM1) with the ipsilateral somatomotor cortex, increased FC with the cingulo-opercular network (CON) as well as the emergence of high amplitude, fMRI signal pulses localized in the contralateral SM1, supplementary motor area and the cerebellum. From our prior observations, it remains unclear whether the disuse plasticity affects the thalamus and striatum. We extended our analysis to include these subcortical regions and found that both exhibit strengthened cortical FC and spontaneous fMRI signal pulses induced by limb disuse. The dorsal posterior putamen and the central thalamus, mainly CM, VLP and VIM nuclei, showed disuse pulses and FC changes that lined up with fmri task activations from the Human connectome project motor system localizer, acquired before casting for each participant. Our findings provide a novel understanding of the role of the cortico-striato-thalamo-cortical loops in human motor plasticity and a potential link with the physiology of sleep regulation. Additionally, similarities with FC observation from Parkinson Disease (PD) questions a pathophysiological link with limb disuse.
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Affiliation(s)
- Roselyne J. Chauvin
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110
| | - Dillan J. Newbold
- Department of Neurology, New York University Grossman School of Medicine, New York, New York 10016, USA
| | - Ashley N. Nielsen
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110
| | - Ryland L. Miller
- Basque Center on Cognition, Brain and Language, Donostia, Gipuzkoa, Spain
| | - Samuel R. Krimmel
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110
| | - Athanasia Metoki
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110
| | - Anxu Wang
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110
- Department of Biomedical Engineering, Washington University in St. Louis, MO 63130
| | - Andrew N. Van
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110
- Division of Computation and Data Science, Washington University School of Medicine, St. Louis, MO 63110
| | - David F. Montez
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110
| | - Scott Marek
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63110
| | - Vahdeta Suljic
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110
| | - Noah J. Baden
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110
| | | | - Kristen M. Scheidter
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110
| | - Julia S. Monk
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110
| | - Forrest I. Whiting
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110
| | - Babatunde Adeyemo
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110
| | - Abraham Z. Snyder
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63110
| | - Benjamin P. Kay
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110
| | - Marcus E. Raichle
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63110
- Department of Psychological and Brain Sciences, Washington University in St. Louis, St Louis, MO, USA
- Department of Neuroscience, Washington University School of Medicine, St Louis, MO, USA
| | - Timothy O. Laumann
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110
| | - Evan M. Gordon
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63110
| | - Nico U.F. Dosenbach
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110
- Department of Biomedical Engineering, Washington University in St. Louis, MO 63130
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO 63110
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Sweet JA, Pace J, Girgis F, Miller JP. Computational Modeling and Neuroimaging Techniques for Targeting during Deep Brain Stimulation. Front Neuroanat 2016; 10:71. [PMID: 27445709 PMCID: PMC4927621 DOI: 10.3389/fnana.2016.00071] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 06/09/2016] [Indexed: 12/15/2022] Open
Abstract
Accurate surgical localization of the varied targets for deep brain stimulation (DBS) is a process undergoing constant evolution, with increasingly sophisticated techniques to allow for highly precise targeting. However, despite the fastidious placement of electrodes into specific structures within the brain, there is increasing evidence to suggest that the clinical effects of DBS are likely due to the activation of widespread neuronal networks directly and indirectly influenced by the stimulation of a given target. Selective activation of these complex and inter-connected pathways may further improve the outcomes of currently treated diseases by targeting specific fiber tracts responsible for a particular symptom in a patient-specific manner. Moreover, the delivery of such focused stimulation may aid in the discovery of new targets for electrical stimulation to treat additional neurological, psychiatric, and even cognitive disorders. As such, advancements in surgical targeting, computational modeling, engineering designs, and neuroimaging techniques play a critical role in this process. This article reviews the progress of these applications, discussing the importance of target localization for DBS, and the role of computational modeling and novel neuroimaging in improving our understanding of the pathophysiology of diseases, and thus paving the way for improved selective target localization using DBS.
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Affiliation(s)
- Jennifer A Sweet
- Department of Neurosurgery, University Hospitals Case Medical Center, Case Western Reserve University Cleveland, OH, USA
| | - Jonathan Pace
- Department of Neurosurgery, University Hospitals Case Medical Center, Case Western Reserve University Cleveland, OH, USA
| | - Fady Girgis
- Department of Neurosurgery, University Hospitals Case Medical Center, Case Western Reserve University Cleveland, OH, USA
| | - Jonathan P Miller
- Department of Neurosurgery, University Hospitals Case Medical Center, Case Western Reserve University Cleveland, OH, USA
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Intraoperative CT verification of electrode localization in DBS surgery in Parkinson's disease. INTERDISCIPLINARY NEUROSURGERY-ADVANCED TECHNIQUES AND CASE MANAGEMENT 2015. [DOI: 10.1016/j.inat.2014.10.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Schlaier JR, Hanson C, Janzen A, Fellner C, Hochreiter A, Proescholdt M, Brawanski A, Lange M. Deep brain stimulation in Parkinson’s disease: motor effects relative to the MRI-defined STN. Neurosurg Rev 2014; 37:461-70; discussion 470-1. [DOI: 10.1007/s10143-014-0521-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Revised: 08/01/2013] [Accepted: 10/27/2013] [Indexed: 10/25/2022]
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Xiao Y, Jannin P, D'Albis T, Guizard N, Haegelen C, Lalys F, Vérin M, Collins DL. Investigation of morphometric variability of subthalamic nucleus, red nucleus, and substantia nigra in advanced Parkinson's disease patients using automatic segmentation and PCA-based analysis. Hum Brain Mapp 2014; 35:4330-44. [PMID: 24652699 DOI: 10.1002/hbm.22478] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Revised: 01/07/2014] [Accepted: 01/16/2014] [Indexed: 01/02/2023] Open
Abstract
Subthalamic nucleus (STN) deep brain stimulation (DBS) is an effective surgical therapy to treat Parkinson's disease (PD). Conventional methods employ standard atlas coordinates to target the STN, which, along with the adjacent red nucleus (RN) and substantia nigra (SN), are not well visualized on conventional T1w MRIs. However, the positions and sizes of the nuclei may be more variable than the standard atlas, thus making the pre-surgical plans inaccurate. We investigated the morphometric variability of the STN, RN and SN by using label-fusion segmentation results from 3T high resolution T2w MRIs of 33 advanced PD patients. In addition to comparing the size and position measurements of the cohort to the Talairach atlas, principal component analysis (PCA) was performed to acquire more intuitive and detailed perspectives of the measured variability. Lastly, the potential correlation between the variability shown by PCA results and the clinical scores was explored.
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Affiliation(s)
- Yiming Xiao
- McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, Canada
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Anatomy of the human subthalamic nucleus: a combined morphometric study. ANATOMY RESEARCH INTERNATIONAL 2013; 2013:319710. [PMID: 24416591 PMCID: PMC3876692 DOI: 10.1155/2013/319710] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2013] [Revised: 10/24/2013] [Accepted: 10/30/2013] [Indexed: 11/17/2022]
Abstract
Purpose. Our purpose was to provide a combined clinically oriented study focused on the detailed anatomy of the human STN, with great respect to its targeting. Methods. For our imaging study, we used cerebral magnetic resonance images (MRIs) from 26 neurosurgical patients and for our anatomic study 32 cerebral hemispheres from 18 normal brains from cadaver donors. We measured and analyzed the STN dimensions (based on its stereotactic coordinates). Results. At stereotactic level Z = −4, the STN length was 7.7 mm on MRIs and 8.1 mm in anatomic specimens. Its width was 6 mm on MRIs and 6.3 mm in anatomic specimens. The STN was averagely visible in 3.2 transverse MRI slices and its maximum dimension was 8.5 mm. The intercommissural distance was 26.3 mm on MRIs and 27.3 mm in anatomic specimens. We found statistically significant difference of the STN width and length between individuals <60 and ≥60 years old. Conclusion. The identification of the STN limits was easier in anatomic specimens than on MRIs and easier on T2 compared to T1-weighted MRIs sections. STN dimensions appear slightly smaller on MRIs. Younger people have wider and longer STN.
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Patil PG, Conrad EC, Aldridge JW, Chenevert TL, Chou KL. The Anatomical and Electrophysiological Subthalamic Nucleus Visualized by 3-T Magnetic Resonance Imaging. Neurosurgery 2013; 71:1089-95; discussion 1095. [DOI: 10.1227/neu.0b013e318270611f] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
ABSTRACT
BACKGROUND:
Accurate localization of the subthalamic nucleus (STN) is critical to the success of deep brain stimulation surgery for Parkinson disease. Recent developments in high-field-strength magnetic resonance imaging (MRI) have made it possible to visualize the STN in greater detail. However, the relationship of the MR-visualized STN to the anatomic, electrophysiological, or atlas-predicted STN remains controversial.
OBJECTIVE:
To evaluate the size of the STN visualized on 3-T MRI compared with anatomic measurements in cadaver studies and to compare the predictions of 3-T MRI and those of the Schaltenbrand-Wahren (SW) atlas for intraoperative STN microelectrode recordings.
METHODS:
We evaluated the STN by 3-T MRI and intraoperative microelectrode recordings in 20 Parkinson disease patients undergoing deep brain stimulation surgery. We compared our findings with anatomic cadaver studies and with the individually scaled SW atlas-based predictions for each patient.
RESULTS:
The dimensions of the 3-T MR-visualized STN were very similar to those of the largest anatomic study (MRI length, width, and height: 9.8 ± 1.6, 11.5 ± 1.6, and 3.7 ± 0.7 mm, respectively; n = 40; cadaver length, width, and height: 9.3 ± 0.7, 10.6 ± 0.9, and 3.1 ± 0.5 mm, respectively; n = 100). The amount of STN traversed during intraoperative microelectrode recordings was better correlated to the 3-T MR-visualized STN than the SW atlas-predicted STN (R = 0.38 vs R = −0.17).
CONCLUSION:
The STN as visualized on 3-T MRI corresponds well with cadaveric anatomic studies and intraoperative electrophysiology. STN visualization with 3-T MRI may be an improvement over SW atlas-based localization for STN deep brain stimulation surgery in Parkinson disease.
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Affiliation(s)
- Parag G. Patil
- Surgical Therapies Improving Movement Program, University of Michigan Health System, Ann Arbor, Michigan
- Departments of Neurosurgery
- Departments of Neurology
- Departments of Biomedical Engineering
| | - Erin C. Conrad
- Surgical Therapies Improving Movement Program, University of Michigan Health System, Ann Arbor, Michigan
- Departments of Neurosurgery
| | - J. Wayne Aldridge
- Surgical Therapies Improving Movement Program, University of Michigan Health System, Ann Arbor, Michigan
- Departments of Neurosurgery
| | | | - Kelvin L. Chou
- Surgical Therapies Improving Movement Program, University of Michigan Health System, Ann Arbor, Michigan
- Departments of Neurosurgery
- Departments of Neurology
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Chrastina J, Novák Z, Baláž M, Říha I, Bočková M, Rektor I. The role of brain shift, patient age, and Parkinson's disease duration in the difference between anatomical and electrophysiological targets for subthalamic stimulation. Br J Neurosurg 2013; 27:676-82. [DOI: 10.3109/02688697.2013.771726] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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A new atlas localization approach for subthalamic nucleus utilizing Chinese visible human head datasets. PLoS One 2013; 8:e57264. [PMID: 23460836 PMCID: PMC3584111 DOI: 10.1371/journal.pone.0057264] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Accepted: 01/18/2013] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To study the possibility of Chinese visible human (CVH) head datasets as brain atlas for locating the subthalamic nucleus (STN) before deep brain stimulation (DBS) surgery. METHODS Optimal head axial and coronal 3.0T, T2-weighted magnetic resonance images (MRI) of 30 patients were obtained. Cross-sectional head images of four CVH head datasets were chosen to establish an average CVH model. All MRI sequences were registered to the CVH model via fiducials in X-, Y-, and Z-direction, respectively, within the same stereotactic space. The correlations between red nucleus (RN) and fiducials, the accuracy of MRI-to-CVH registration, and the coordinate value differences of RN gravity center between MRI and CVH were tested. RESULTS The mean gravity center coordinate values and ranges of STN in CVH were measured; The X coordinate value of RN positively correlates with the most anterior point of putamen(PU-A), the lateral edges of putamens (PU-L), and width of the third ventricle, negatively correlated with the patients' age; The minimal mean errors were when no fiducials were used when locating RN between the MRI and the CVH average model; There were no significant differences of RN in X- and Y-direction between MRI sequences and CVH. CONCLUSION CVH head datasets can be used as brain atlas for Chinese STN localization. Moreover, average coordinate values of the gravity center and the ranges of STN in CVH can be considered as references for locating STN.
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Connolly PJ, Halpern CH, Baltuch GH, Danish SF, Jaggi JL. Implications for programming strategy of the location of the active contact in subthalamic nucleus deep brain stimulation. J Clin Neurosci 2012; 19:1029-31. [DOI: 10.1016/j.jocn.2011.12.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2011] [Accepted: 12/13/2011] [Indexed: 11/30/2022]
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Discrepancies between the MRI- and the electrophysiologically defined subthalamic nucleus. Acta Neurochir (Wien) 2011; 153:2307-18. [PMID: 21744142 DOI: 10.1007/s00701-011-1081-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2011] [Accepted: 06/22/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND The aim of our study was to evaluate discrepancies between the electrophysiologically and MRI-defined subthalamic nucleus (STN) in order to contribute to the ongoing debate of whether or not microelectrode recording (MER) provides additional information to image-guided targeting in deep brain stimulation. METHODS Forty-four STNs in 22 patients with Parkinson's disease were investigated. The three-dimensional MRI-defined STN was derived from segmentations of axial and coronal T2-weighted images. The electrophysiological STNs were generated from intraoperative MERs in 1,487 locations. The stereotactical coordinates of positive and negative STN recordings were re-imported to the planning software, where a three-dimensional reconstruction of the electrophysiological STN was performed and fused to the MRI data set. The estimated borders of the MRI- and MER-STN were compared. For statistical analysis Student's t, Mann-Whitney rank sum and Fisher's exact tests were used. RESULTS MER-STN volumes, which were found outside the MRI-STN, ranged from 0 mm(3) to 87 mm(3) (mean: 45 mm(3)). A mean of 44% of the MER-STN volumes exceeded the MRI-STN (maximum: 85.1%; minimum: 15.1 %); 53.4% (n = 793) of the microelectrode recordings were concordant and 46.6% (n = 694) discordant with the MRI-defined anatomical STN. Regarding the dorsal borders, we found discrepancies between the MER- and MRI-STN of 0.27 mm (= mean; SD: 0.51 mm) on the first operated side and 1.51 mm (SD: 1.5 mm) on the second (p = 0.010, t-test). CONCLUSIONS MER provides additional information to high-resolution anatomical MR images and may help to detect the amount and direction of brain shift.
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Brunenberg EJL, Platel B, Hofman PAM, Ter Haar Romeny BM, Visser-Vandewalle V. Magnetic resonance imaging techniques for visualization of the subthalamic nucleus. J Neurosurg 2011; 115:971-84. [PMID: 21800960 DOI: 10.3171/2011.6.jns101571] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The authors reviewed 70 publications on MR imaging-based targeting techniques for identifying the subthalamic nucleus (STN) for deep brain stimulation in patients with Parkinson disease. Of these 70 publications, 33 presented quantitatively validated results. There is still no consensus on which targeting technique to use for surgery planning; methods vary greatly between centers. Some groups apply indirect methods involving anatomical landmarks, or atlases incorporating anatomical or functional data. Others perform direct visualization on MR imaging, using T2-weighted spin echo or inversion recovery protocols. The combined studies do not offer a straightforward conclusion on the best targeting protocol. Indirect methods are not patient specific, leading to varying results between cases. On the other hand, direct targeting on MR imaging suffers from lack of contrast within the subthalamic region, resulting in a poor delineation of the STN. These deficiencies result in a need for intraoperative adaptation of the original target based on test stimulation with or without microelectrode recording. It is expected that future advances in MR imaging technology will lead to improvements in direct targeting. The use of new MR imaging modalities such as diffusion MR imaging might even lead to the specific identification of the different functional parts of the STN, such as the dorsolateral sensorimotor part, the target for deep brain stimulation.
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Affiliation(s)
- Ellen J L Brunenberg
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands.
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Deogaonkar M, Freitas T, Machado A, Rezai A. Subthalamic nucleus targeting using interpeduncular cistern as an internal landmark. Neurosurgery 2011; 69:ons225-9. [PMID: 21709594 DOI: 10.1227/neu.0b013e31822a5453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Internal landmarks for the subthalamic nucleus (STN) have been used in past. This study uses a yet-unused internal landmark to refine STN targeting. OBJECTIVE To determine the effect of the width of the interpeduncular cistern (IPC) on STN targeting during placement of deep brain stimulation (DBS) for Parkinson disease. METHODS Fifty consecutive patients with Parkinson disease underwent 90 STN DBS implantations. X, Y, and Z coordinates for the tip of the DBS electrodes and the active contact were recorded. Internal landmarks such as width of the third ventricle, width of IPC at a predefined point, and anterior commissure-posterior commissure length were measured. Statistical analysis was done using linear regression analysis and Pearson correlation coefficient. RESULTS The average IPC diameter at the predefined point was 7.59 mm (range, 5- to 14 mm). Average X, Y, and Z coordinates for the location of the tip of lead were 11.5, -3.5, -5.4, and those of the location of active contact were 12.5, -1.9, -1.4 from the midcommissural point. The mediolateral location of the tip of the DBS as well as the location of the active contact for long-term stimulation were greatly dependent on IPC width (r = 0.83) (P = .0022). CONCLUSION The width of the IPC is a strong predictor of laterality of STN DBS electrode placement in patients with Parkinson disease. It can be used as an additional internal landmark for refining STN targeting using the simple formula X coordinate for STN target = 0.6 × IPC width + 7 mm.
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Affiliation(s)
- Milind Deogaonkar
- Department of Neurosurgery, Cleveland Clinic Foundation, Center for Neurological Restoration, Cleveland, Ohio, USA.
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Assessment of the variability in the anatomical position and size of the subthalamic nucleus among patients with advanced Parkinson's disease using magnetic resonance imaging. Acta Neurochir (Wien) 2010; 152:201-10; discussion 210. [PMID: 19806309 DOI: 10.1007/s00701-009-0514-z] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2009] [Accepted: 09/08/2009] [Indexed: 12/23/2022]
Abstract
PURPOSE Targeting of the subthalamic nucleus (STN) during deep brain stimulation (DBS) surgery using standard atlas coordinates is used in some centers. Such coordinates are accurate for only a subgroup of patients, and subgroup size depends on the extent of inter-individual variation in STN position/size and degree to which atlas represents average anatomical relations. Few studies have addressed this issue. METHODS Sixty-two axial T(2)-weighted magnetic resonance (MR) images of the brain (1.5 T) were obtained before STN-DBS in 62 patients (37 males) with Parkinson's disease using a protocol optimized for STN visualization. Image distortion was within sub-millimeter range. Midcommissural point (MCP)-derived coordinates of STN borders, STN center, and other brain landmarks were obtained using stereotactic software. MR-derived measurements were compared to Schaltenbrand and Wahren Atlas. RESULTS We evaluated 117 best-visualized STNs. STN dimensions and coordinates of its center were highly variable. STN lateral coordinate ranged 8.7 mm-14.5 mm from MCP, A-P coordinate 3.5 mm posterior to 0.5 mm anterior to MCP, and vertical coordinate 1.3 mm-6 mm below MCP. The antero-posterior nucleus dimension varied by 8 mm and lateral-medial dimension by 5.8 mm. Differences between mean values of MR-derived data sets and Atlas values were statistically significant but moderate, excluding AC-PC length, for which the Atlas value was below the 1st percentile of the MR data set. The STN lateral coordinate strongly correlated with the width of the third ventricle (r = 0.73, p < 0.001). CONCLUSIONS It is now possible to directly evaluate STNs at 1.5 T with minimal image distortion, which reveals variation in STN position and dimensions in the range of nucleus size. This puts under question the rationale of use of standard STN coordinates during DBS surgery.
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Yamada K, Akazawa K, Yuen S, Goto M, Matsushima S, Takahata A, Nakagawa M, Mineura K, Nishimura T. MR imaging of ventral thalamic nuclei. AJNR Am J Neuroradiol 2009; 31:732-5. [PMID: 19926703 DOI: 10.3174/ajnr.a1870] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The Vim and VPL are important target regions of the thalamus for DBS. Our aim was to clarify the anatomic locations of the ventral thalamic nuclei, including the Vim and VPL, on MR imaging. MATERIALS AND METHODS Ten healthy adult volunteers underwent MR imaging by using a 1.5T whole-body scanner. The subjects included 5 men and 5 women, ranging in age from 23 to 38 years, with a mean age of 28 years. The subjects were imaged with STIR sequences (TR/TE/TI = 3200 ms/15 ms/120 ms) and DTI with a single-shot echo-planar imaging technique (TR/TE = 6000 ms/88 ms, b-value = 2000 s/mm(2)). Tractography of the CTC and spinothalamic pathway was used to identify the thalamic nuclei. Tractography of the PT was used as a reference, and the results were superimposed on the STIR image, FA map, and color-coded vector map. RESULTS The Vim, VPL, and PT were all in close contact at the level through the ventral thalamus. The Vim was bounded laterally by the PT and medially by the IML. The VPL was bounded anteriorly by the Vim, laterally by the internal capsule, and medially by the IML. The posterior boundary of the VPL was defined by a band of low FA that divided the VPL from the pulvinar. CONCLUSIONS The ventral thalamic nuclei can be identified on MR imaging by using reference structures such as the PT and the IML.
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Affiliation(s)
- K Yamada
- Departments of Radiology, Kyoto Prefectural University of Medicine, Japan.
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Toda H, Sawamoto N, Hanakawa T, Saiki H, Matsumoto S, Okumura R, Ishikawa M, Fukuyama H, Hashimoto N. A novel composite targeting method using high-field magnetic resonance imaging for subthalamic nucleus deep brain stimulation. J Neurosurg 2009; 111:737-45. [PMID: 19326982 DOI: 10.3171/2008.12.jns0861] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Accurate localization of the subthalamic nucleus (STN) is important for proper placement of the electrodes in deep brain stimulation (DBS) surgery for patients with advanced Parkinson disease. The authors evaluated the accuracy of our modified composite targeting method and the value of using high-field MR imaging for targeting the STN. METHODS Thirteen patients with advanced Parkinson disease underwent bilateral STN DBS based on 3-T MR imaging, and 13 patients underwent surgery based on 1.5-T MR imaging. By sequentially referring to the postmammillary commissure, the red nucleus, the mammillothalamic tract, and the STN, the modified composite targeting method determined the stereotactic coordinates for targeting the STN. The accuracy and efficacy of the composite targeting method and 3-T MR imaging were evaluated by using the intraoperative microelectrode recording, the postoperative imaging study, and the postoperative clinical improvement. RESULTS The landmark structures for targeting the STN were visualized clearly with 3-T MR imaging. The mean (+/- SD) path length through the STN of the central track was 4.9 +/- 1.1 mm in the 3-T group and 3.1 +/- 2.0 mm in the 1.5-T group (p < 0.001). Twenty-one (81%) of 26 electrodes were placed in the central track in the 3-T group, whereas 8 (31%) of 26 electrodes were placed in the central track in the 1.5-T group (p = 0.006). The rest of the electrodes were placed in the noncentral optimum track for alleviating parkinsonian motor symptoms. The mean Unified Parkinson's Disease Rating Scale motor part score during off period was reduced by 53% in the 3-T group and by 41% in the 1.5-T group (p = 0.14). The mean reductions of levodopa equivalent daily doses were 48.6% in the 3-T group and 43.7% in the 1.5-T group (p = 0.61). CONCLUSIONS The use of the modified composite targeting method referring to the multiple landmarks with 3-T MR imaging offers reliable and clinically effective target for STN DBS surgery.
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Affiliation(s)
- Hiroki Toda
- Department of Neurosurgery, Tazuke Kofukai Medical Research Institute and Kitano Hospital, Osaka, Japan.
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Luján JL, Noecker AM, Butson CR, Cooper SE, Walter BL, Vitek JL, McIntyre CC. Automated 3-dimensional brain atlas fitting to microelectrode recordings from deep brain stimulation surgeries. Stereotact Funct Neurosurg 2009; 87:229-40. [PMID: 19556832 DOI: 10.1159/000225976] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Deep brain stimulation (DBS) surgeries commonly rely on brain atlases and microelectrode recordings (MER) to help identify the target location for electrode implantation. We present an automated method for optimally fitting a 3-dimensional brain atlas to intraoperative MER and predicting a target DBS electrode location in stereotactic coordinates for the patient. METHODS We retrospectively fit a 3-dimensional brain atlas to MER points from 10 DBS surgeries targeting the subthalamic nucleus (STN). We used a constrained optimization algorithm to maximize the MER points correctly fitted (i.e., contained) within the appropriate atlas nuclei. We compared our optimization approach to conventional anterior commissure-posterior commissure (AC/PC) scaling, and to manual fits performed by four experts. A theoretical DBS electrode target location in the dorsal STN was customized to each patient as part of the fitting process and compared to the location of the clinically defined therapeutic stimulation contact. RESULTS The human expert and computer optimization fits achieved significantly better fits than the AC/PC scaling (80, 81, and 41% of correctly fitted MER, respectively). However, the optimization fits were performed in less time than the expert fits and converged to a single solution for each patient, eliminating interexpert variance. CONCLUSIONS AND SIGNIFICANCE DBS therapeutic outcomes are directly related to electrode implantation accuracy. Our automated fitting techniques may aid in the surgical decision-making process by optimally integrating brain atlas and intraoperative neurophysiological data to provide a visual guide for target identification.
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Affiliation(s)
- J Luis Luján
- Department of Biomedical Engineering, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
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