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Vitek JL, Patriat R, Ingham L, Reich MM, Volkmann J, Harel N. Lead location as a determinant of motor benefit in subthalamic nucleus deep brain stimulation for Parkinson’s disease. Front Neurosci 2022; 16:1010253. [PMID: 36267235 PMCID: PMC9577320 DOI: 10.3389/fnins.2022.1010253] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 09/05/2022] [Indexed: 11/19/2022] Open
Abstract
Background Subthalamic nucleus (STN) deep brain stimulation (DBS) is regarded as an effective treatment for patients with advanced Parkinson’s disease (PD). Clinical benefit, however, varies significantly across patients. Lead location has been hypothesized to play a critical role in determining motor outcome and may account for much of the observed variability reported among patients. Objective To retrospectively evaluate the relationship of lead location to motor outcomes in patients who had been implanted previously at another center by employing a novel visualization technology that more precisely determines the location of the DBS lead and its contacts with respect to each patient’s individually defined STN. Methods Anatomical models were generated using novel imaging in 40 PD patients who had undergone bilateral STN DBS (80 electrodes) at another center. Patient-specific models of each STN were evaluated to determine DBS electrode contact locations with respect to anterior to posterior and medial to lateral regions of the individualized STNs and compared to the change in the contralateral hemi-body Unified Parkinson’s Disease Rating Scale Part III (UPDRS-III) motor score. Results The greatest improvement in hemi-body motor function was found when active contacts were located within the posterolateral portion of the STN (71.5%). Motor benefit was 52 and 36% for central and anterior segments, respectively. Active contacts within the posterolateral portion also demonstrated the greatest reduction in levodopa dosage (77%). Conclusion The degree of motor benefit was dependent on the location of the stimulating contact within the STN. Although other factors may play a role, we provide further evidence in support of the hypothesis that lead location is a critical factor in determining clinical outcomes in STN DBS.
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Affiliation(s)
- Jerrold L. Vitek
- Department of Neurology, University of Minnesota, Minneapolis, MN, United States
- *Correspondence: Jerrold L. Vitek,
| | - Rémi Patriat
- Department of Radiology, Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN, United States
| | | | - Martin M. Reich
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - Jens Volkmann
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - Noam Harel
- Department of Radiology, Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN, United States
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Merola A, Singh J, Reeves K, Changizi B, Goetz S, Rossi L, Pallavaram S, Carcieri S, Harel N, Shaikhouni A, Sammartino F, Krishna V, Verhagen L, Dalm B. New Frontiers for Deep Brain Stimulation: Directionality, Sensing Technologies, Remote Programming, Robotic Stereotactic Assistance, Asleep Procedures, and Connectomics. Front Neurol 2021; 12:694747. [PMID: 34367055 PMCID: PMC8340024 DOI: 10.3389/fneur.2021.694747] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 06/14/2021] [Indexed: 11/21/2022] Open
Abstract
Over the last few years, while expanding its clinical indications from movement disorders to epilepsy and psychiatry, the field of deep brain stimulation (DBS) has seen significant innovations. Hardware developments have introduced directional leads to stimulate specific brain targets and sensing electrodes to determine optimal settings via feedback from local field potentials. In addition, variable-frequency stimulation and asynchronous high-frequency pulse trains have introduced new programming paradigms to efficiently desynchronize pathological neural circuitry and regulate dysfunctional brain networks not responsive to conventional settings. Overall, these innovations have provided clinicians with more anatomically accurate programming and closed-looped feedback to identify optimal strategies for neuromodulation. Simultaneously, software developments have simplified programming algorithms, introduced platforms for DBS remote management via telemedicine, and tools for estimating the volume of tissue activated within and outside the DBS targets. Finally, the surgical accuracy has improved thanks to intraoperative magnetic resonance or computerized tomography guidance, network-based imaging for DBS planning and targeting, and robotic-assisted surgery for ultra-accurate, millimetric lead placement. These technological and imaging advances have collectively optimized DBS outcomes and allowed “asleep” DBS procedures. Still, the short- and long-term outcomes of different implantable devices, surgical techniques, and asleep vs. awake procedures remain to be clarified. This expert review summarizes and critically discusses these recent innovations and their potential impact on the DBS field.
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Affiliation(s)
- Aristide Merola
- Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Jaysingh Singh
- Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Kevin Reeves
- Department of Psychiatry, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Barbara Changizi
- Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Steven Goetz
- Medtronic PLC Neuromodulation, Minneapolis, MN, United States
| | | | | | | | - Noam Harel
- Center for Magnetic Resonance Research, University of Minnesota Medical School, Minneapolis, MN, United States
| | - Ammar Shaikhouni
- Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Francesco Sammartino
- Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Vibhor Krishna
- Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Leo Verhagen
- Movement Disorder Section, Department of Neurological Sciences, Rush University, Chicago, IL, United States
| | - Brian Dalm
- Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, OH, United States
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Quirin T, Féry C, Vogel D, Vergne C, Sarracanie M, Salameh N, Madec M, Hemm S, Hébrard L, Pascal J. Towards Tracking of Deep Brain Stimulation Electrodes Using an Integrated Magnetometer. SENSORS (BASEL, SWITZERLAND) 2021; 21:2670. [PMID: 33920125 PMCID: PMC8068940 DOI: 10.3390/s21082670] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/07/2021] [Accepted: 04/08/2021] [Indexed: 11/16/2022]
Abstract
This paper presents a tracking system using magnetometers, possibly integrable in a deep brain stimulation (DBS) electrode. DBS is a treatment for movement disorders where the position of the implant is of prime importance. Positioning challenges during the surgery could be addressed thanks to a magnetic tracking. The system proposed in this paper, complementary to existing procedures, has been designed to bridge preoperative clinical imaging with DBS surgery, allowing the surgeon to increase his/her control on the implantation trajectory. Here the magnetic source required for tracking consists of three coils, and is experimentally mapped. This mapping has been performed with an in-house three-dimensional magnetic camera. The system demonstrates how magnetometers integrated directly at the tip of a DBS electrode, might improve treatment by monitoring the position during and after the surgery. The three-dimensional operation without line of sight has been demonstrated using a reference obtained with magnetic resonance imaging (MRI) of a simplified brain model. We observed experimentally a mean absolute error of 1.35 mm and an Euclidean error of 3.07 mm. Several areas of improvement to target errors below 1 mm are also discussed.
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Affiliation(s)
- Thomas Quirin
- Institute for Medical Engineering and Medical Informatics, School of Life Sciences, University of Applied Sciences and Arts Northwestern Switzerland (FHNW), 4132 Muttenz, Switzerland; (C.F.); (D.V.); (C.V.); (S.H.); (J.P.)
- Icube laboratory, UMR 7357 (University of Strasbourg/CNRS), 67412 Illkirch, France; (M.M.); (L.H.)
| | - Corentin Féry
- Institute for Medical Engineering and Medical Informatics, School of Life Sciences, University of Applied Sciences and Arts Northwestern Switzerland (FHNW), 4132 Muttenz, Switzerland; (C.F.); (D.V.); (C.V.); (S.H.); (J.P.)
| | - Dorian Vogel
- Institute for Medical Engineering and Medical Informatics, School of Life Sciences, University of Applied Sciences and Arts Northwestern Switzerland (FHNW), 4132 Muttenz, Switzerland; (C.F.); (D.V.); (C.V.); (S.H.); (J.P.)
- Department of Biomedical Engineering, Linköping University, 581 83 Linköping, Sweden
| | - Céline Vergne
- Institute for Medical Engineering and Medical Informatics, School of Life Sciences, University of Applied Sciences and Arts Northwestern Switzerland (FHNW), 4132 Muttenz, Switzerland; (C.F.); (D.V.); (C.V.); (S.H.); (J.P.)
- Icube laboratory, UMR 7357 (University of Strasbourg/CNRS), 67412 Illkirch, France; (M.M.); (L.H.)
| | - Mathieu Sarracanie
- Center for Adaptable MRI Technology, Department of Biomedical Engineering, University of Basel, 4123 Allschwil, Switzerland; (M.S.); (N.S.)
| | - Najat Salameh
- Center for Adaptable MRI Technology, Department of Biomedical Engineering, University of Basel, 4123 Allschwil, Switzerland; (M.S.); (N.S.)
| | - Morgan Madec
- Icube laboratory, UMR 7357 (University of Strasbourg/CNRS), 67412 Illkirch, France; (M.M.); (L.H.)
| | - Simone Hemm
- Institute for Medical Engineering and Medical Informatics, School of Life Sciences, University of Applied Sciences and Arts Northwestern Switzerland (FHNW), 4132 Muttenz, Switzerland; (C.F.); (D.V.); (C.V.); (S.H.); (J.P.)
- Department of Biomedical Engineering, Linköping University, 581 83 Linköping, Sweden
| | - Luc Hébrard
- Icube laboratory, UMR 7357 (University of Strasbourg/CNRS), 67412 Illkirch, France; (M.M.); (L.H.)
| | - Joris Pascal
- Institute for Medical Engineering and Medical Informatics, School of Life Sciences, University of Applied Sciences and Arts Northwestern Switzerland (FHNW), 4132 Muttenz, Switzerland; (C.F.); (D.V.); (C.V.); (S.H.); (J.P.)
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Nguyen TAK, Schüpbach M, Mercanzini A, Dransart A, Pollo C. Directional Local Field Potentials in the Subthalamic Nucleus During Deep Brain Implantation of Parkinson's Disease Patients. Front Hum Neurosci 2020; 14:521282. [PMID: 33192384 PMCID: PMC7556345 DOI: 10.3389/fnhum.2020.521282] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 09/15/2020] [Indexed: 11/29/2022] Open
Abstract
Segmented deep brain stimulation leads feature directional electrodes that allow for a finer spatial control of electrical stimulation compared to traditional ring-shaped electrodes. These segmented leads have demonstrated enlarged therapeutic windows and have thus the potential to improve the treatment of Parkinson's disease patients. Moreover, they provide a unique opportunity to record directional local field potentials. Here, we investigated whether directional local field potentials can help identify the best stimulation direction to assist device programming. Four Parkinson's disease patients underwent routine implantation of the subthalamic nucleus. Firstly, local field potentials were recorded in three directions for two conditions: In one condition, the patient was at rest; in the other condition, the patient's arm was moved. Secondly, current thresholds for therapeutic and side effects were identified intraoperatively for directional stimulation. Therapeutic windows were calculated from these two thresholds. Thirdly, the spectral power of the total beta band (13-35 Hz) and its sub-bands low, high, and peak beta were analyzed post hoc. Fourthly, the spectral power was used by different algorithms to predict the ranking of directions. The spectral power profiles were patient-specific, and spectral peaks were found both in the low beta band (13-20 Hz) and in the high beta band (20.5-35 Hz). The direction with the highest spectral power in the total beta band was most indicative of the 1st best direction when defined by therapeutic window. Based on the total beta band, the resting condition and the moving condition were similarly predictive about the direction ranking and classified 83.3% of directions correctly. However, different algorithms were needed to predict the ranking defined by therapeutic window or therapeutic current threshold. Directional local field potentials may help predict the best stimulation direction. Further studies with larger sample sizes are needed to better distinguish the informative value of different conditions and the beta sub-bands.
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Affiliation(s)
- T. A. Khoa Nguyen
- Department of Neurosurgery, University Hospital of Bern, Bern, Switzerland
| | - Michael Schüpbach
- Department of Neurology, University Hospital of Bern, Bern, Switzerland
| | - André Mercanzini
- Microsystems Laboratory 4, School of Engineering, EPF Lausanne, Lausanne, Switzerland
- Aleva Neurotherapeutics SA, Lausanne, Switzerland
| | | | - Claudio Pollo
- Department of Neurosurgery, University Hospital of Bern, Bern, Switzerland
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Automated detection of subthalamic nucleus in deep brain stimulation surgery for Parkinson’s disease using microelectrode recordings and wavelet packet features. J Neurosci Methods 2020; 343:108826. [DOI: 10.1016/j.jneumeth.2020.108826] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 06/22/2020] [Indexed: 01/02/2023]
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A review on microelectrode recording selection of features for machine learning in deep brain stimulation surgery for Parkinson’s disease. Clin Neurophysiol 2019; 130:145-154. [DOI: 10.1016/j.clinph.2018.09.018] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 08/28/2018] [Accepted: 09/17/2018] [Indexed: 12/17/2022]
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Ispierto L, Muñoz J, Cladellas JM, Cuadras P, Capellades J, Latorre P, Dávalos A, Vancamp T, Álvarez R. Post-Operative Localization of Deep Brain Stimulation Electrodes in the Subthalamus Using Transcranial Sonography. Neuromodulation 2017; 21:574-581. [PMID: 29178240 DOI: 10.1111/ner.12733] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 05/19/2017] [Accepted: 06/16/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The correct positioning of deep brain stimulation electrodes determines the success of surgery. In this study, we attempt to validate transcranial sonography (TCS) as a method for early postoperative confirmation of electrode location in the subthalamic nucleus (STN). MATERIALS AND METHODS Nineteen patients diagnosed with Parkinson's disease were enrolled in the study. Postoperative TCS was applied to measure the distance between the implanted electrodes and the third ventricle in the axial plane. Whether the electrodes were positioned within or outside the substantia nigra (SN) was evaluated through measurements in the coronal plane. The obtained metrics through TCS were compared with those from postoperative computed tomography (CT) and magnetic resonance imaging (MRI). RESULTS A statistically significant correlation between distances from electrode to third ventricle by TCS and CT/MRI (r = 0.75, p < 0.01) was observed. Distances from third ventricle to electrodes tips were different when sonographically they showed to be inside or outside the SN (p < 0.01). A cut-off value of 8.85mm in these distances was the most sensitive (100%) and specific (90.5%) to predict if electrodes were positioned inside the SN (CI 95% 0.81-10.30, p = 0.001). CONCLUSIONS Transcranial sonography is a useful technique to reliably identify targeted positioning of deep brain stimulation electrodes in or out of the SN.
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Affiliation(s)
- Lourdes Ispierto
- Department of Neurology and Neurosciences, University Hospital Germans Trias i Pujol, Badalona, Spain
| | - Jorge Muñoz
- Department of Neurosurgery and Neurosciences, University Hospital Germans Trias i Pujol, Badalona, Spain
| | - Josep Maria Cladellas
- Department of Neurosurgery and Neurosciences, University Hospital Germans Trias i Pujol, Badalona, Spain
| | - Patricia Cuadras
- Department of Radiology, University Hospital Germans Trias i Pujol, Badalona, Spain
| | - Jaume Capellades
- Image Diagnosis Institute, Badalona, Spain.,Department of Medical Imaging Consorci MAR Parc de Salut, Barcelona, Spain
| | - Pilar Latorre
- Department of Neurology and Neurosciences, University Hospital Germans Trias i Pujol, Badalona, Spain
| | - Antoni Dávalos
- Department of Neurology and Neurosciences, University Hospital Germans Trias i Pujol, Badalona, Spain
| | - Tim Vancamp
- BRAI2N, St. Augustinus Hospital, Wilrijk, Belgium
| | - Ramiro Álvarez
- Department of Neurology and Neurosciences, University Hospital Germans Trias i Pujol, Badalona, Spain
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Shenai MB, Patel DM, Romeo A, Whisenhunt JD, Walker HC, Guthrie S, Guthrie BL. The Relationship of Electrophysiologic Subthalamic Nucleus Length as a Predictor of Outcomes in Deep Brain Stimulation for Parkinson Disease. Stereotact Funct Neurosurg 2017; 95:341-347. [PMID: 28982098 DOI: 10.1159/000478023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Accepted: 06/05/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Intraoperative measurement of subthalamic nucleus (STN) width through microelectrode recording (MER) is a common proxy for optimal electrode location during deep brain stimulation (DBS) surgery for Parkinson disease. We assessed whether the MER-determined STN width is a predictor of postoperative Unified Parkinson Disease Rating Scale (UPDRS) improvement. METHODS Records were reviewed for patients who underwent single-sided STN DBS placement for Parkinson disease between 2005 and 2010 at the UAB Medical Center. Reviews of preoperative and 3-month postoperative UPDRS part III, intraoperative MER records, and postoperative MRI scans were conducted. RESULTS The final cohort consisted of 73 patients (mean age 59 ± 9.7 years, length of disease 13 ± 9.7 years). STN widths were defined as depths associated with increased background activity and motor-driven, spiking action potentials on MER. The mean contralateral UPDRS improvement was 58% (± 24). The mean STN width was 5.1 mm (± 1.6, min = 0.0, max = 8.7). No significant relationship between STN width and UPDRS improvement was found, with and without AC-PC normalization (R2 < 0.05). CONCLUSION This analysis raises questions about seeking the maximal electrophysiological width of STN as a proxy for optimal outcome in DBS for PD. We suggest this strategy for DBS placement in Parkinson disease be subject to more robust prospective investigation.
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Affiliation(s)
- Mahesh B Shenai
- Inova Medical Group Department of Neurosurgery, Fairfax, VA, USA
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Li Z, Zhang JG, Ye Y, Li X. Review on Factors Affecting Targeting Accuracy of Deep Brain Stimulation Electrode Implantation between 2001 and 2015. Stereotact Funct Neurosurg 2016; 94:351-362. [PMID: 27784015 DOI: 10.1159/000449206] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 08/16/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Accurate implantation of a depth electrode into the brain is of the greatest importance in deep brain stimulation (DBS), and various stereotactic systems have been developed for electrode implantation. However, an updated analysis of depth electrode implantation in the modern era of DBS is lacking. OBJECTIVE This study aims at providing an updated review on targeting accuracy of DBS electrode implantation by analyzing contemporary DBS electrode implantation operations from the perspective of precision engineering. METHODS Eligible articles with information on targeting accuracy of DBS electrode implantation were searched in the PubMed database. RESULTS An average targeting error of DBS electrode implantation is reported to decrease toward 1 mm; the standard deviation of targeting error is decreasing toward 0.5 mm. Targeting accuracy is not only found to be affected by individual surgical steps, but also systematically affected by the architecture of the implantation operation. CONCLUSION A systematic strategy should be adopted to further improve the targeting accuracy of depth electrode implantation. Attention should be paid to optimizing the whole electrode implantation operation, which can help minimize error accumulation or amplification throughout the serially connected procedures for DBS electrode implantation.
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Affiliation(s)
- Zhe Li
- Department of Biomedical Engineering, National University of Singapore, Singapore, Singapore
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Sammartino F, Krishna V, King NKK, Bruno V, Kalia S, Hodaie M, Marras C, Lozano AM, Fasano A. Sequence of electrode implantation and outcome of deep brain stimulation for Parkinson's disease. J Neurol Neurosurg Psychiatry 2016; 87:859-63. [PMID: 26354942 DOI: 10.1136/jnnp-2015-311426] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 08/17/2015] [Indexed: 11/03/2022]
Abstract
INTRODUCTION The effect of the variability of electrode placement on outcomes after bilateral deep brain stimulation of subthalamic nucleus has not been sufficiently studied, especially with respect to the sequence of hemisphere implantation. METHODOLOGY We retrospectively analysed the clinical and radiographic data of all the consecutive patients with Parkinson's disease who underwent surgery at our centre and completed at least 1 year follow-up. The dispersion in electrode location was calculated by the square of deviation from population mean, and the direction of deviation was analysed by comparing the intended and final implantation coordinates. Linear regression analysis was performed to analyse the predictors of postoperative improvement of the motor condition, also controlling for the sequence of implanted hemisphere. RESULTS 76 patients (mean age 58±7.2 years) were studied. Compared with the first side, the second side electrode tip had significantly higher dispersion as an overall effect (5.6±21.6 vs 2.2±4.9 mm(2), p=0.04), or along the X-axis (4.1±15.6 vs 1.4±2.4 mm(2), p=0.03) and Z-axis (4.9±11.5 vs 2.9±3.6 mm(2), p=0.02); the second side stimulation was also associated with a lower threshold for side effects (contact 0, p<0.001 and contact 3, p=0.004). In the linear regression analysis, the significant predictors of outcome were baseline activities of daily living (p=0.010) and dispersion of electrode on the second side (p=0.005). CONCLUSIONS We observed a higher dispersion for the electrode on the second implanted side, which also resulted to be a significant predictor of motor outcome at 1 year.
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Affiliation(s)
- Francesco Sammartino
- Division of Neurosurgery, University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Vibhor Krishna
- Division of Neurosurgery, University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Nicolas Kon Kam King
- Division of Neurosurgery, University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Veronica Bruno
- Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital - UHN, Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Suneil Kalia
- Division of Neurosurgery, University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Mojgan Hodaie
- Division of Neurosurgery, University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Connie Marras
- Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital - UHN, Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Andres M Lozano
- Division of Neurosurgery, University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Alfonso Fasano
- Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital - UHN, Division of Neurology, University of Toronto, Toronto, Ontario, Canada
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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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Liu Y, Dawant BM. Multi-modal Learning-based Pre-operative Targeting in Deep Brain Stimulation Procedures. ... IEEE-EMBS INTERNATIONAL CONFERENCE ON BIOMEDICAL AND HEALTH INFORMATICS. IEEE-EMBS INTERNATIONAL CONFERENCE ON BIOMEDICAL AND HEALTH INFORMATICS 2016; 2016:17-20. [PMID: 27754497 PMCID: PMC5042326 DOI: 10.1109/bhi.2016.7455824] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Deep brain stimulation, as a primary surgical treatment for various neurological disorders, involves implanting electrodes to stimulate target nuclei within millimeter accuracy. Accurate pre-operative target selection is challenging due to the poor contrast in its surrounding region in MR images. In this paper, we present a learning-based method to automatically and rapidly localize the target using multi-modal images. A learning-based technique is applied first to spatially normalize the images in a common coordinate space. Given a point in this space, we extract a heterogeneous set of features that capture spatial and intensity contextual patterns at different scales in each image modality. Regression forests are used to learn a displacement vector of this point to the target. The target is predicted as a weighted aggregation of votes from various test samples, leading to a robust and accurate solution. We conduct five-fold cross validation using 100 subjects and compare our method to three indirect targeting methods, a state-of-the-art statistical atlas-based approach, and two variations of our method that use only a single modality image. With an overall error of 2.63±1.37mm, our method improves upon the single modality-based variations and statistically significantly outperforms the indirect targeting ones. Our technique matches state-of-the-art registration methods but operates on completely different principles. Both techniques can be used in tandem in processing pipelines operating on large databases or in the clinical flow for automated error detection.
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Affiliation(s)
- Yuan Liu
- Electrical Engineering and Computer Science, Vanderbilt University, Nashville, TN, USA
| | - Benoit M Dawant
- Electrical Engineering and Computer Science, Vanderbilt University, Nashville, TN, USA
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Bériault S, Sadikot AF, Alsubaie F, Drouin S, Collins DL, Pike GB. Neuronavigation using susceptibility-weighted venography: application to deep brain stimulation and comparison with gadolinium contrast. J Neurosurg 2014; 121:131-41. [DOI: 10.3171/2014.3.jns131860] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Careful trajectory planning on preoperative vascular imaging is an essential step in deep brain stimulation (DBS) to minimize risks of hemorrhagic complications and postoperative neurological deficits. This paper compares 2 MRI methods for visualizing cerebral vasculature and planning DBS probe trajectories: a single data set T1-weighted scan with double-dose gadolinium contrast (T1w-Gd) and a multi–data set protocol consisting of a T1-weighted structural, susceptibility-weighted venography, and time-of-flight angiography (T1w-SWI-TOF). Two neurosurgeons who specialize in neuromodulation surgery planned bilateral STN DBS in 18 patients with Parkinson's disease (36 hemispheres) using each protocol separately. Planned trajectories were then evaluated across all vascular data sets (T1w-Gd, SWI, and TOF) to detect possible intersection with blood vessels along the entire path via an objective vesselness measure. The authors' results show that trajectories planned on T1w-SWI-TOF successfully avoided the cerebral vasculature imaged by conventional T1w-Gd and did not suffer from missing vascular information or imprecise data set registration. Furthermore, with appropriate planning and visualization software, trajectory corridors planned on T1w-SWI-TOF intersected significantly less fine vasculature that was not detected on the T1w-Gd (p < 0.01 within 2 mm and p < 0.001 within 4 mm of the track centerline). The proposed T1w-SWI-TOF protocol comes with minimal effects on the imaging and surgical workflow, improves vessel avoidance, and provides a safe cost-effective alternative to injection of gadolinium contrast.
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Affiliation(s)
| | - Abbas F. Sadikot
- 1McConnell Brain Imaging Centre and
- 2Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, Quebec; and
| | - Fahd Alsubaie
- 1McConnell Brain Imaging Centre and
- 2Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, Quebec; and
| | - Simon Drouin
- 1McConnell Brain Imaging Centre and
- 2Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, Quebec; and
| | | | - G. Bruce Pike
- 3Department of Radiology, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada
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Linte CA, Davenport KP, Cleary K, Peters C, Vosburgh KG, Navab N, Edwards PE, Jannin P, Peters TM, Holmes DR, Robb RA. On mixed reality environments for minimally invasive therapy guidance: systems architecture, successes and challenges in their implementation from laboratory to clinic. Comput Med Imaging Graph 2013; 37:83-97. [PMID: 23632059 PMCID: PMC3796657 DOI: 10.1016/j.compmedimag.2012.12.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2012] [Revised: 11/16/2012] [Accepted: 12/24/2012] [Indexed: 11/21/2022]
Abstract
Mixed reality environments for medical applications have been explored and developed over the past three decades in an effort to enhance the clinician's view of anatomy and facilitate the performance of minimally invasive procedures. These environments must faithfully represent the real surgical field and require seamless integration of pre- and intra-operative imaging, surgical instrument tracking, and display technology into a common framework centered around and registered to the patient. However, in spite of their reported benefits, few mixed reality environments have been successfully translated into clinical use. Several challenges that contribute to the difficulty in integrating such environments into clinical practice are presented here and discussed in terms of both technical and clinical limitations. This article should raise awareness among both developers and end-users toward facilitating a greater application of such environments in the surgical practice of the future.
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Abstract
We present a novel method for preoperative computer-assisted deep brain stimulation (DBS) electrode targeting that takes into account the multiplicity of available contacts and their polarity. Our framework automatically evaluates the efficacy of many possible electrode orientations to optimize the interplay between the extracellular electric field, created from distinct arrangements of active contacts, and anatomical structures responsible for therapeutic and potential side effects. Experimental results on subthalamic DBS cases suggest bipolar configurations provide more flexibility and control on the spread of electric field and, consequently, are most robust to targeting imprecision. Visualization of predicted efficacy maps provides surgeons with complementary feedback that can bridge the gap between insertion safety and optimal therapeutic efficacy. Overall, this work adds a new dimension to preoperative DBS planning and suggests new insights regarding multi-target stimulation.
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16
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Multimodal imaging and image analysis techniques for neuromodulation. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2012. [PMID: 23206685 DOI: 10.1016/b978-0-12-404706-8.00012-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register]
Abstract
Functional neurosurgical procedures used to treat the debilitating motor symptoms of Parkinson's disease and that target small subcortical structures have typically relied on semi-qualitative manual approaches that rely upon the establishing qualitative between volumetric imaging data and print atlases. This chapter reviews many new high -precision and -accuracy techniques that can be used for the full automated localization of these targets. These techniques rely on the a priori development of neuroanatomical atlases derived from magnetic resonance imaging data, high-resolution identification of subcortical structures from histology, and spatially localized data bases of intra-operative recordings and successful surgical outcomes. Other novel structural and functional MRI techniques that allow for the direct visualization of thalamic sub nuclei are also reviewed.
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Kerl HU, Gerigk L, Pechlivanis I, Al-Zghloul M, Groden C, Nölte I. The subthalamic nucleus at 3.0 Tesla: choice of optimal sequence and orientation for deep brain stimulation using a standard installation protocol: clinical article. J Neurosurg 2012; 117:1155-65. [PMID: 23039154 DOI: 10.3171/2012.8.jns111930] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECT Reliable visualization of the subthalamic nucleus (STN) is indispensable for accurate placement of electrodes in deep brain stimulation (DBS) surgery for patients with Parkinson disease (PD). The aim of the study was to evaluate different promising new MRI methods at 3.0 T for preoperative visualization of the STN using a standard installation protocol. METHODS Magnetic resonance imaging studies (T2-FLAIR, T1-MPRAGE, T2*-FLASH2D, T2-SPACE, and susceptibility-weighted imaging sequences) obtained in 9 healthy volunteers and in 1 patient with PD were acquired. Two neuroradiologists independently analyzed image quality and visualization of the STN using a 6-point scale. Interrater reliability, contrast-to-noise ratios, and signal-to-noise ratios for the STN were calculated. For illustration of the anatomical accuracy, coronal T2*-FLASH2D images were fused with the corresponding coronal section schema of the Schaltenbrand and Wahren stereotactic atlas. RESULTS The STN was best and reliably visualized on T2*-FLASH2D imaging (in particular, the coronal view). No major artifacts in the STN were observed in any of the sequences. Susceptibility-weighted, T2-SPACE, and T2*-FLASH2D imaging provided significantly higher contrast-to-noise ratio values for the STN than standard T2-weighted imaging. Fusion of the coronal T2*-FLASH2D and the digitized coronal atlas view projected the STN clearly within the boundaries of the STN found in anatomical sections. CONCLUSIONS For 3.0-T MRI, T2*-FLASH2D (particularly the coronal view) provides optimal delineation of the STN using a standard installation protocol.
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Affiliation(s)
- Hans U Kerl
- Department of Neuroradiology, University of Heidelberg, Medical Faculty Mannheim, Heidelberg, Germany
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18
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Automated segmentation of basal ganglia and deep brain structures in MRI of Parkinson's disease. Int J Comput Assist Radiol Surg 2012; 8:99-110. [PMID: 22426551 DOI: 10.1007/s11548-012-0675-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Accepted: 02/17/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE Template-based segmentation techniques have been developed to facilitate the accurate targeting of deep brain structures in patients with movement disorders. Three template-based brain MRI segmentation techniques were compared to determine the best strategy for segmenting the deep brain structures of patients with Parkinson's disease. METHODS T1-weighted and T2-weighted magnetic resonance (MR) image templates were created by averaging MR images of 57 patients with Parkinson's disease. Twenty-four deep brain structures were manually segmented on the templates. To validate the template-based segmentation, 14 of the 24 deep brain structures from the templates were manually segmented on 10 MR scans of Parkinson's patients as a gold standard. We compared the manual segmentations with three methods of automated segmentation: two registration-based approaches, automatic nonlinear image matching and anatomical labeling (ANIMAL) and symmetric image normalization (SyN), and one patch-label fusion technique. The automated labels were then compared with the manual labels using a Dice-kappa metric and center of gravity. A Friedman test was used to compare the Dice-kappa values and paired t tests for the center of gravity. RESULTS The Friedman test showed a significant difference between the three methods for both thalami (p < 0.05) and not for the subthalamic nuclei. Registration with ANIMAL was better than with SyN for the left thalamus and was better than the patch-based method for the right thalamus. CONCLUSION Although template-based approaches are the most used techniques to segment basal ganglia by warping onto MR images, we found that the patch-based method provided similar results and was less time-consuming. Patch-based method may be preferable for the subthalamic nucleus segmentation in patients with Parkinson's disease.
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Ben-Haim S, Gologorsky Y, Monahan A, Weisz D, Alterman RL. Fiducial registration with spoiled gradient-echo magnetic resonance imaging enhances the accuracy of subthalamic nucleus targeting. Neurosurgery 2011; 69:870-5; discussion 875. [PMID: 21552170 DOI: 10.1227/neu.0b013e318222ae33] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND A variety of imaging strategies may be used to derive reliable stereotactic coordinates when performing deep brain stimulation lead implants. No single technique has yet proved optimal. OBJECTIVE To compare the relative accuracy of stereotactic coordinates for the subthalamic nucleus (STN) derived either from fast spin echo/inversion recovery (FSE/IR) magnetic resonance imaging MRI alone (group 1) or FSE/IR in conjunction with T1-weighted spoiled gradient-echo MRI (group 2). METHODS A retrospective analysis of 145 consecutive STN deep brain stimulation lead placements (group 1, n = 72; group 2, n = 73) was performed in 81 Parkinson disease patients by 1 surgical team. From the operative reports, we recorded the number of microelectrode recording trajectories required to localize the desired STN target and the span of STN traversed along the implantation trajectory. In addition, we calculated the 3-dimensional vector difference between the initial MRI-derived coordinates and the final physiologically refined coordinates. RESULTS The proportion of implants completed with just 1 microelectrode recording trajectory was greater (81% vs 58%; P < .001) and the 3-dimensional vector difference between the anatomically selected target and the microelectrode recording-refined target was smaller (0.6 ± 1.2 vs 0.9 ± 1.3; P = .04) in group 2 than in group 1. At the same time, the mean expanse of STN recorded along the implantation trajectory was 8% greater in group 2 (4.8 ± 0.6 vs 5.2 ± 0.6 mm; P < .001). CONCLUSION A combination of stereotactic FSE/IR and spoiled gradient-echo MRI yields more accurate coordinates for the STN than FSE/IR MRI alone.
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Affiliation(s)
- Sharona Ben-Haim
- Department of Neurosurgery, Mount Sinai School of Medicine, New York, NY, USA
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20
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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: 39] [Impact Index Per Article: 3.0] [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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21
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Wang MN, Song ZJ. Classification and Analysis of the Errors in Neuronavigation. Neurosurgery 2011; 68:1131-43; discussion 1143. [DOI: 10.1227/neu.0b013e318209cc45] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
There are many different types of errors in neuronavigation, and the reasons and results of these errors are complex. For a neurosurgeon using the neuronavigation system, it is important to have a clear understanding of when an error may occur, what the magnitude of it is, and how to avoid it or reduce its influence on the final application accuracy. In this article, we classify all the errors into 2 groups according to the working principle of neuronavigation systems. The first group contains the errors caused by the differences between the anatomic structures in the images and that of the real patient, and the second group contains the errors occurring in transforming the position of surgical tools from the patient space to the image space. Each group is further divided into 2 subgroups. We discuss 16 types of errors and classify each of them into one of the subgroups. The classification and analysis of these errors should help neurosurgeons understand the power and limits of neuronavigation systems and use them more properly.
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Affiliation(s)
- Man Ning Wang
- Digital Medical Research Center, Shanghai Medical School, Fudan University, and Shanghai Key Lab of Medical Image Computing and Computer Assisted Intervention, Shanghai, China
| | - Zhi Jian Song
- Digital Medical Research Center, Shanghai Medical School, Fudan University, and Shanghai Key Lab of Medical Image Computing and Computer Assisted Intervention, Shanghai, China
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Stereotactic implantation of deep brain stimulation electrodes: a review of technical systems, methods and emerging tools. Med Biol Eng Comput 2010; 48:611-24. [DOI: 10.1007/s11517-010-0633-y] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2010] [Accepted: 05/05/2010] [Indexed: 10/19/2022]
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Marceglia S, Servello D, Foffani G, Porta M, Sassi M, Mrakic-Sposta S, Rosa M, Barbieri S, Priori A. Thalamic single-unit and local field potential activity in Tourette syndrome. Mov Disord 2010; 25:300-8. [PMID: 20108375 DOI: 10.1002/mds.22982] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Deep brain stimulation (DBS) of the ventralis oralis (VO) complex of the thalamus improves tics in patients with Tourette syndrome (TS). To neurophysiologically describe the VO complex we recorded, in seven patients with TS undergoing DBS electrode implantation, single-unit activity during surgery and local field potentials (LFPs) a few days after surgery. Single unit recordings showed that the VO complex is characterized by a localized pattern of bursting neuronal activity. LFP spectra demonstrated that VO of TS patients has a prominent oscillatory activity at low frequencies (2-7 Hz) and in the alpha-band (8-13 Hz), and a virtually absent beta activity. In each patient, the main LFP frequency significantly correlated with single-unit interburst frequency. In conclusion, we observed an oscillatory bursting activity in the VO as target region in patients with severe TS undergoing DBS surgery.
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Affiliation(s)
- Sara Marceglia
- Centro Clinico per le Neuronanotecnologie e la Neurostimolazione, Fondazione IRCCS Ospedale Maggiore, Policlinico, Mangiagalli e Regina Elena, Università di Milano, Milano, Italy
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Multicenter study report: electrophysiological monitoring procedures for subthalamic deep brain stimulation surgery in Parkinson’s disease. Neurol Sci 2010; 31:449-57. [DOI: 10.1007/s10072-010-0254-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2009] [Accepted: 03/11/2010] [Indexed: 11/26/2022]
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Lalys F, Haegelen C, Ferre JC, El-Ganaoui O, Jannin P. Construction and assessment of a 3-T MRI brain template. Neuroimage 2009; 49:345-54. [PMID: 19682582 DOI: 10.1016/j.neuroimage.2009.08.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2009] [Revised: 07/15/2009] [Accepted: 08/05/2009] [Indexed: 10/20/2022] Open
Abstract
New MR imaging protocols enable visualization of brain structures. However, for dedicated clinical applications such as targeting deep brain stimulation (DBS), a more accurate localization requires the use of atlases. We developed a three-dimensional digitized mono-subject anatomical template of the human brain based on 3-T magnetic resonance images (MRI). By averaging 15 registered T1 image acquisitions, we have shown that the final image corresponds to an optimal image, limited by the performance of the 3-T MR machine. We compared different preprocessing workflows for template construction. With the optimal strategy, along with validated existing processing methods, one T1 template and one T1-T2 mixing template were created in order to improve visualization of spatially complex deep structures. Reduction of voxel size to 0.25 mm(3) was also advantageous to observe fine structures and white matter/gray matter intensity crossings. Results demonstrated that such a template also improved inter-patient registration for population comparison in DBS. These MR templates are made freely available to our community (http://www.vmip.org/mritemplate) to serve as a reference for neuroimage processing methods.
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Affiliation(s)
- Florent Lalys
- INSERM U746, Faculté de Médecine CS 34317, Rennes Cedex, France
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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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