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Baldi S, Schuhmann T, Goossens L, Schruers KRJ. Individualized, connectome-based, non-invasive stimulation of OCD deep-brain targets: A proof-of-concept. Neuroimage 2024; 288:120527. [PMID: 38286272 DOI: 10.1016/j.neuroimage.2024.120527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 12/09/2023] [Accepted: 01/26/2024] [Indexed: 01/31/2024] Open
Abstract
Treatment-resistant obsessive-compulsive disorder (OCD) generally improves with deep-brain stimulation (DBS), thought to modulate neural activity at both the implantation site and in connected brain regions. However, its invasive nature, side-effects, and lack of customization, make non-invasive treatments preferable. Harnessing the established remote effects of cortical transcranial magnetic stimulation (TMS), connectivity-based approaches have emerged for depression that aim at influencing distant regions connected to the stimulation site. We here investigated whether effective OCD DBS targets (here subthalamic nucleus [STN] and nucleus accumbens [NAc]) could be modulated non-invasively with TMS. In a proof-of-concept study with nine healthy individuals, we used 7T magnetic resonance imaging (MRI) and probabilistic tractography to reconstruct the fiber tracts traversing manually segmented STN/NAc. Two TMS targets were individually selected based on the strength of their structural connectivity to either the STN, or both the STN and NAc. In a sham-controlled, within-subject cross-over design, TMS was administered over the personalized targets, located around the precentral and middle frontal gyrus. Resting-state functional 3T MRI was acquired before, and at 5 and 25 min after stimulation to investigate TMS-induced changes in the functional connectivity of the STN and NAc with other regions of the brain. Static and dynamic seed-to-voxel correlation analyses were conducted. TMS over both targets was able to modulate the functional connectivity of the STN and NAc, engaging both overlapping and distinct regions, and unfolding following different temporal dynamics. Given the relevance of the engaged connected regions to OCD pathology, we argue that a personalized, connectivity-based procedure is worth investigating as potential treatment for refractory OCD.
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Affiliation(s)
- Samantha Baldi
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands.
| | - Teresa Schuhmann
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands; Maastricht Brain Imaging Centre, Maastricht, the Netherlands
| | - Liesbet Goossens
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Koen R J Schruers
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
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2
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Wiśniewski K, Gajos A, Zaczkowski K, Szulia A, Grzegorczyk M, Dąbkowska A, Wójcik R, Bobeff EJ, Kwiecień K, Brandel MG, Fahlström A, Bogucki A, Ciszek B, Jaskólski DJ. Overlapping stimulation of subthalamic nucleus and dentato-rubro-thalamic tract in Parkinson's disease after deep brain stimulation. Acta Neurochir (Wien) 2024; 166:106. [PMID: 38403814 DOI: 10.1007/s00701-024-06006-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 02/09/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND Deep brain stimulation (DBS) of the subthalamic nucleus (STN) reduces tremor, rigidity, and akinesia. According to the literature, the dentato-rubro-thalamic tract (DRTt) is verified target for DBS in essential tremor; however, its role in the treatment of Parkinson's disease is only vaguely described. The aim of our study was to identify the relationship between symptom alleviation in PD patients and the distance of the DBS electrode electric field (EF) to the DRTt. METHODS A single-center retrospective analysis of patients (N = 30) with idiopathic Parkinson's disease (PD) who underwent DBS between November 2018 and January 2020 was performed. DRTt and STN were visualized using diffusion-weighted imaging (DWI) and tractography protocol of magnetic resonance (MR). The EF was calculated and compared with STN and course of DRTt. Evaluation of patients before and after surgery was performed with use of UPDRS-III scale. The association between distance from EF to DRTt and clinical outcomes was examined. To confirm the anatomical variation between DRTt and STN observed in tractography, white matter dissection was performed with the Klingler technique on ten human brains. RESULTS Patients with EF overlapping STN and DRTt benefited from significant motor symptoms improvement. Anatomical findings confirmed the presence of population differences in variability of the DRTt course and were consistent with the DRTt visualized by MR. CONCLUSIONS DRTt proximity to STN, the main target in PD DBS surgery, confirmed by DWI with tractography protocol of MR combined with proper predefined stimulation parameters may improve efficacy of DBS-STN.
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Affiliation(s)
- K Wiśniewski
- Department of Neurosurgery and Neurooncology, Medical University of Łódź, Barlicki University Hospital, Łódź, Poland.
| | - A Gajos
- Department of Extrapyramidal Diseases, Medical University of Łódź, Łódź, Poland
| | - K Zaczkowski
- Department of Neurosurgery and Neurooncology, Medical University of Łódź, Barlicki University Hospital, Łódź, Poland
| | - A Szulia
- Department of Neurosurgery and Neurooncology, Medical University of Łódź, Barlicki University Hospital, Łódź, Poland
| | - M Grzegorczyk
- Department of Descriptive and Clinical Anatomy, Medical University of Warsaw, Warsaw, Poland
| | - A Dąbkowska
- Department of Forensic Medicine, Medical University of Warsaw, Warsaw, Poland
| | - R Wójcik
- Department of Neurosurgery and Neurooncology, Medical University of Łódź, Barlicki University Hospital, Łódź, Poland
| | - E J Bobeff
- Department of Neurosurgery and Neurooncology, Medical University of Łódź, Barlicki University Hospital, Łódź, Poland
- Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, Łódź, Poland
| | - K Kwiecień
- Department of Neurosurgery and Neurooncology, Medical University of Łódź, Barlicki University Hospital, Łódź, Poland
| | - M G Brandel
- Department of Neurosurgery, University of California, San Diego, San Diego, CA, 92123, USA
| | - A Fahlström
- Department of Medical Sciences, Section of Neurosurgery, Uppsala University, Uppsala, Sweden
| | - A Bogucki
- Department of Extrapyramidal Diseases, Medical University of Łódź, Łódź, Poland
| | - B Ciszek
- Department of Descriptive and Clinical Anatomy, Medical University of Warsaw, Warsaw, Poland
| | - D J Jaskólski
- Department of Neurosurgery and Neurooncology, Medical University of Łódź, Barlicki University Hospital, Łódź, Poland
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Hvingelby VS, Pavese N. Surgical Advances in Parkinson's Disease. Curr Neuropharmacol 2024; 22:1033-1046. [PMID: 36411569 PMCID: PMC10964101 DOI: 10.2174/1570159x21666221121094343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 10/24/2022] [Accepted: 10/29/2022] [Indexed: 11/23/2022] Open
Abstract
While symptomatic pharmacological therapy remains the main therapeutic strategy for Parkinson's disease (PD), over the last two decades, surgical approaches have become more commonly used to control levodopa-induced motor complications and dopamine-resistant and non-motor symptoms of PD. In this paper, we discuss old and new surgical treatments for PD and the many technological innovations in this field. We have initially reviewed the relevant surgical anatomy as well as the pathological signaling considered to be the underlying cause of specific symptoms of PD. Subsequently, early attempts at surgical symptom control will be briefly reviewed. As the most well-known surgical intervention for PD is deep brain stimulation, this subject is discussed at length. As deciding on whether a patient stands to benefit from DBS can be quite difficult, the different proposed paradigms for precisely this are covered. Following this, the evidence regarding different targets, especially the subthalamic nucleus and internal globus pallidus, is reviewed as well as the evidence for newer proposed targets for specific symptoms. Due to the rapidly expanding nature of knowledge and technological capabilities, some of these new and potential future capabilities are given consideration in terms of their current and future use. Following this, we have reviewed newer treatment modalities, especially magnetic resonance-guided focused ultrasound and other potential surgical therapies, such as spinal cord stimulation for gait symptoms and others. As mentioned, the field of surgical alleviation of symptoms of PD is undergoing a rapid expansion, and this review provides a general overview of the current status and future directions in the field.
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Affiliation(s)
- Victor S. Hvingelby
- Department of Clinical Medicine, Nuclear Medicine and PET Center, Aarhus University, Aarhus, Denmark
| | - Nicola Pavese
- Department of Clinical Medicine, Nuclear Medicine and PET Center, Aarhus University, Aarhus, Denmark
- Clinical Ageing Research Unit, Newcastle Upon Tyne, Newcastle University, United Kingdom
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4
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Reese R, Kriesen T, Kersten M, Löhle M, Cantré D, Freiman TM, Storch A, Walter U. Combining ultrasound and microelectrode recordings for postoperative localization of subthalamic electrodes in Parkinson's disease. Clin Neurophysiol 2023; 156:196-206. [PMID: 37972531 DOI: 10.1016/j.clinph.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 10/10/2023] [Accepted: 11/01/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVE To assess transcranial sonography (TCS) as stand-alone tool and in combination with microelectrode recordings (MER) as a method for the postoperative localization of deep brain stimulation (DBS) electrodes in the subthalamic nucleus (STN). METHODS Individual dorsal and ventral boundaries of STN (n = 12) were determined on intraoperative MER. Postoperatively, a standardized TCS protocol was applied to measure medio-lateral, anterior-posterior and rostro-caudal electrode position using visualized reference structures (midline, substantia nigra). TCS and combined TCS-MER data were validated using fusion-imaging and clinical outcome data. RESULTS Test-retest reliability of standard TCS measures of electrode position was excellent. Computed tomography and TCS measures of distance between distal electrode contact and midline agreed well (Pearson correlation; r = 0.86; p < 0.001). Comparing our "gold standard" of rostro-caudal electrode localization relative to STN boundaries, i.e. combining MRI-based stereotaxy and MER data, with the combination of TCS and MER data, the measures differed by 0.32 ± 0.87 (range, -1.35 to 1.25) mm. Combined TCS-MER data identified the clinically preferred electrode contacts for STN-DBS with high accuracy (Coheńs kappa, 0.86). CONCLUSIONS Combined TCS-MER data allow for exact localization of STN-DBS electrodes. SIGNIFICANCE Our method provides a new option for monitoring of STN-DBS electrode location and guidance of DBS programming in Parkinson's disease.
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Affiliation(s)
- René Reese
- Department of Neurology, Rostock University Medical Center, Rostock, Germany.
| | - Thomas Kriesen
- Department of Neurosurgery, Rostock University Medical Center, Rostock, Germany
| | - Maxi Kersten
- Department of Neurology, Rostock University Medical Center, Rostock, Germany; Center for Transdisciplinary Neurosciences Rostock (CTNR), Rostock University Medical Center, Rostock, Germany
| | - Matthias Löhle
- Department of Neurology, Rostock University Medical Center, Rostock, Germany; German Center for Neurodegenerative Diseases (DZNE) Rostock / Greifswald, Rostock, Germany
| | - Daniel Cantré
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, Rostock University Medical Center, Rostock, Germany
| | - Thomas M Freiman
- Department of Neurosurgery, Rostock University Medical Center, Rostock, Germany
| | - Alexander Storch
- Department of Neurology, Rostock University Medical Center, Rostock, Germany; Center for Transdisciplinary Neurosciences Rostock (CTNR), Rostock University Medical Center, Rostock, Germany; German Center for Neurodegenerative Diseases (DZNE) Rostock / Greifswald, Rostock, Germany
| | - Uwe Walter
- Department of Neurology, Rostock University Medical Center, Rostock, Germany; Center for Transdisciplinary Neurosciences Rostock (CTNR), Rostock University Medical Center, Rostock, Germany; German Center for Neurodegenerative Diseases (DZNE) Rostock / Greifswald, Rostock, Germany.
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5
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Bronte-Stewart H, Merola A. Hope vs. Hype: Closed loop technology will provide more meaningful improvement vs. directional leads in deep brain stimulation. Parkinsonism Relat Disord 2023:105452. [PMID: 37355400 DOI: 10.1016/j.parkreldis.2023.105452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 05/20/2023] [Indexed: 06/26/2023]
Affiliation(s)
- Helen Bronte-Stewart
- Department of Neurology and Neurological Sciences, Stanford Comprehensive Movement Disorders Center, United States.
| | - Aristide Merola
- Center for Parkinson's Disease and Related Movement Disorders, Wexner Medical Center, The Ohio State University, Columbus, United States.
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Kuzucu P, Çeltikçi P, Demirtaş OK, Canbolat Ç, Çeltikçi E, Demirci H, Özışık P, Tubbs RS, Pamir MN, Güngör A. Arterial Supply of the Basal Ganglia: A Fiber Dissection Study. Oper Neurosurg (Hagerstown) 2023; 24:e351-e359. [PMID: 36719962 DOI: 10.1227/ons.0000000000000612] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 11/01/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The basal ganglia, a group of subcortical nuclei located deep in the insular cortex, are responsible for many functions such as motor learning, emotion, and behavior control. Nowadays, because it has been shown that deep brain stimulation and insular tumor surgery can be performed by endovascular treatment, the importance of the vascular anatomy of the basal ganglia is being increasingly recognized. OBJECTIVE To explain the arterial blood supply of the basal ganglia using white matter dissection. METHODS The Klingler protocol was used to prepare 12 silicone-injected human hemispheres. The dissections were performed from lateral to medial with the fiber dissection technique to preserve arteries. RESULTS The globus pallidus blood supply came from the medial lenticulostriate, lateral lenticulostriate, and anterior choroidal arteries; the substantia nigra and subthalamic nucleus were supplied by the branches of posterior cerebral artery; the putamen was supplied by the lateral and medial lenticulostriate arteries; and the caudate nucleus was supplied by the lateral lenticulostriate and medial lenticulostriate arteries and the recurrent artery of Heubner. CONCLUSION Knowledge of the detailed anatomy of the basal ganglia and its vascular supply is essential for avoiding postoperative ischemic complications in surgeries related to the insula. In addition, knowledge of this anatomy and vascular relationship opens the doors to endovascular deep brain stimulation treatment. This study provides a 3-dimensional understanding of the blood supply to the basal ganglia by examining it using the fiber dissection technique. Further studies could use advanced imaging modalities to explore the vascular relationships with critical structures in the brain.
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Affiliation(s)
- Pelin Kuzucu
- Department of Neurosurgery, Bilkent City Hospital, Ankara, Türkiye
| | - Pınar Çeltikçi
- Department of Radiology, Bilkent City Hospital, Ankara, Türkiye
| | - Oğuz Kağan Demirtaş
- Department of Neurosurgery, Gazi Universtiy Faculty of Medicine, Ankara, Türkiye
| | - Çağrı Canbolat
- Neurosurgery Clinic, Liv Hospital Vadi İstanbul Hospital, İstanbul, Türkiye
| | - Emrah Çeltikçi
- Department of Neurosurgery, Gazi Universtiy Faculty of Medicine, Ankara, Türkiye
| | - Harun Demirci
- Department of Neurosurgery, Ankara Yıldırım Beyazıt University Faculty of Medicine, Ankara, Türkiye
| | - Pınar Özışık
- Department of Neurosurgery, Ankara Yıldırım Beyazıt University Faculty of Medicine, Ankara, Türkiye
| | - R Shane Tubbs
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - M Necmettin Pamir
- Department of Neurosurgery, Acıbadem Mehmet Ali Aydınlar University, İstanbul, Türkiye
| | - Abuzer Güngör
- Department of Neurosurgery, Yeditepe University Faculty of Medicine, İstanbul, Türkiye.,Department of Neurosurgery, Bakırköy Research and Training Hospital for Psyhiatry, Neurology and Neurosurgery, İstanbul, Türkiye
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7
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Kähkölä J, Lahtinen M, Keinänen T, Katisko J. Stimulation of the Presupplementary Motor Area Cluster of the Subthalamic Nucleus Predicts More Consistent Clinical Outcomes. Neurosurgery 2022; 92:1058-1065. [PMID: 36700693 DOI: 10.1227/neu.0000000000002292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 10/05/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND The development of diffusion tensor imaging and tractography has raised increasing interest in the functional targeting of deep brain stimulation of the subthalamic nucleus (STN) in Parkinson disease. OBJECTIVE To study, using deterministic tractography, the functional subdivisions of the STN and hyperdirect white matter connections located between the STN and the medial frontal cortex, especially the presupplementary motor area (preSMA), SMA, primary motor area (M1), and dorsolateral premotor cortex, and to study retrospectively whether this information correlates with clinical outcome. METHODS Twenty-two patients with Parkinson disease who underwent STN deep brain stimulation were analyzed. Using 3 T MR images, the medial frontal cortex was manually segmented into preSMA, SMA, M1, and dorsolateral premotor cortex, which were then used to determine the functional subdivisions of the lateral border of the STN. The intersectional quantities of the volume of activated tissue (VAT) and the hyperdirect white matter connections were calculated. The results were combined with clinical data including unilateral 12-month postoperative motor outcome and levodopa equivalent daily dose. RESULTS Stimulated clusters of the STN were connected mostly to the cortical SMA and preSMA regions. Patients with primarily preSMA cluster stimulation (presmaVAT% ≥ 50%) had good responses to the treatment with unilateral motor improvement over 40% and levodopa equivalent daily dose reduction over 60%. Larger VAT was not found to correlate with better patient outcomes. CONCLUSION Our study is the first to suggest that stimulating, predominantly, the STN cluster where preSMA hyperdirect pathways are located, could be predictive of more consistent treatment results.
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Affiliation(s)
- Johannes Kähkölä
- Oulu Research Group of Advanced Surgical Technologies and Physics - ORGASTP, Medical Research Center, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Maija Lahtinen
- Oulu Research Group of Advanced Surgical Technologies and Physics - ORGASTP, Medical Research Center, Oulu University Hospital, University of Oulu, Oulu, Finland.,Neurocenter, Oulu University Hospital, Oulu, Finland
| | - Tuija Keinänen
- Oulu Research Group of Advanced Surgical Technologies and Physics - ORGASTP, Medical Research Center, Oulu University Hospital, University of Oulu, Oulu, Finland.,Neurocenter, Oulu University Hospital, Oulu, Finland
| | - Jani Katisko
- Oulu Research Group of Advanced Surgical Technologies and Physics - ORGASTP, Medical Research Center, Oulu University Hospital, University of Oulu, Oulu, Finland.,Neurocenter, Oulu University Hospital, Oulu, Finland
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8
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Gurses ME, Gungor A, Rahmanov S, Gökalp E, Hanalioglu S, Berker M, Cohen-Gadol AA, Türe U. Three-Dimensional Modeling and Augmented Reality and Virtual Reality Simulation of Fiber Dissection of the Cerebellum and Brainstem. Oper Neurosurg (Hagerstown) 2022; 23:345-354. [DOI: 10.1227/ons.0000000000000358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 05/24/2022] [Indexed: 11/07/2022] Open
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9
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Demirtaş OK, Güngör A, Çeltikçi P, Çeltikçi E, Munoz-Gualan AP, Doğulu FH, Türe U. Microsurgical anatomy and insular connectivity of the cerebral opercula. J Neurosurg 2022; 137:1509-1523. [PMID: 35303697 DOI: 10.3171/2021.12.jns212297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 12/20/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Radiological, anatomical, and electrophysiological studies have shown the insula and cerebral opercula to have extremely high functionality. Because of this complexity, interventions in this region cause higher morbidity compared to those in other areas of the brain. In most early studies of the insula and white matter pathways, insular dissection was begun after the opercula were removed. In this study, the authors examined the insula and deep white matter pathways to evaluate the insula as a whole with the surrounding opercula. METHODS Twenty formalin-fixed adult cerebral hemispheres were studied using fiber microdissection techniques and examination of sectional anatomy. Dissections were performed from lateral to medial, medial to lateral, inferior to superior, and superior to inferior. A silicone brain model was used to show the normal gyral anatomy. Sections and fibers found at every stage of dissection were photographed with a professional camera. MRI tractography studies were used to aid understanding of the dissections. RESULTS The relationships between the insula and cerebral opercula were investigated in detail through multiple dissections and sections. The relationship of the extreme and external capsules with the surrounding opercula and the fronto-occipital fasciculus with the fronto-orbital operculum was demonstrated. These findings were correlated with the tractography studies. Fibers of the extreme capsule connect the medial aspect of the opercula with the insula through the peri-insular sulcus. Medial to lateral dissections were followed with the removal of the central core structures, and in the last step, the medial surface of the cerebral opercula was evaluated in detail. CONCLUSIONS This anatomical study clarifies our understanding of the insula and cerebral opercula, which have complex anatomical and functional networks. This study also brings a new perspective to the connection of the insula and cerebral opercula via the extreme and external capsules.
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Affiliation(s)
- Oğuz Kağan Demirtaş
- 1Department of Neurosurgery, Gazi University Hospital, Ankara
- 2Department of Neurosurgery, Yeditepe University School of Medicine, Istanbul
- 3Department of Neurosurgery, Sincan Nafiz Körfez State Hospital, Ankara
| | - Abuzer Güngör
- 2Department of Neurosurgery, Yeditepe University School of Medicine, Istanbul
- 4Department of Neurosurgery, Bakirköy Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul
| | - Pınar Çeltikçi
- 5Department of Radiology, Ankara Bilkent City Hospital, Ankara, Turkey; and
| | - Emrah Çeltikçi
- 1Department of Neurosurgery, Gazi University Hospital, Ankara
| | - Alberth Patricio Munoz-Gualan
- 2Department of Neurosurgery, Yeditepe University School of Medicine, Istanbul
- 6Department of Nervous Disease and Neurosurgery, Peoples' Friendship University of Russia, Moscow, Russia
| | | | - Uğur Türe
- 2Department of Neurosurgery, Yeditepe University School of Medicine, Istanbul
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10
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Li M, Zhang Z, Wu X, Wang X, Liu X, Liang J, Chen G, Feng Y, Li M. Tractography of the Stria Terminalis in the Human Brain. Clin Anat 2022; 35:383-391. [PMID: 35102603 DOI: 10.1002/ca.23843] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 01/24/2022] [Accepted: 01/26/2022] [Indexed: 11/08/2022]
Abstract
The aim of this study was to investigate the trajectory of the stria terminalis and develop a protocol for mapping the stria terminalis using multi-shell diffusion images based tractography. The stria terminalis was reconstructed by combining one region of interest at the amygdala with another region of interest at the bed nucleus of stria terminalis. In addition, one region of avoidance was placed on the fornix at the interventricular foramen and another was set at the anterior perforated substance. The fiber-tracking protocol was tested in a Human Connectome Project-842 template, 35 healthy subjects from Massachusetts General Hospital, and 20 healthy subjects from the Human Connectome Project using generalized q-sampling imaging based tractography. The stria terminalis was reconstructed in the Human Connectome Project-842 template, 35 Massachusetts General Hospital healthy subjects, and 20 Human Connectome Project healthy subjects with our protocol. The stria terminalis originated from the amygdala and travelled parallel to the fornix. Then, the stria terminalis followed a C-shaped trajectory around the inferior, posterior, and dorsal surfaces of the thalamus before projecting to the bed nucleus of stria terminalis between the thalamus and caudate nucleus. There were no significant differences in the quantitative anisotropy and fractional anisotropy values between the left and right stria terminalis. The stria terminalis was accurately visualized across subjects using multi-shell diffusion images through generalized q-sampling imaging based tractography. This method could be an important tool for the reconstruction and evaluation of the stria terminalis in various neurological disorders. One Sentence Summary The visualizetion of the stria terminalis through the multi-shell diffusion images using generalized q-sampling imaging based tractography.
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Affiliation(s)
- Mengjun Li
- Department of Neurosurgery, Samii Clinical Neuroanatomy Research & Education Center, Capital Medical University Xuanwu Hospital, China International Neuroscience Institute (China-INI), Beijing, China
| | - Zhiping Zhang
- Department of Neurosurgery, Samii Clinical Neuroanatomy Research & Education Center, Capital Medical University Xuanwu Hospital, China International Neuroscience Institute (China-INI), Beijing, China
| | - Xiaolong Wu
- Department of Neurosurgery, Samii Clinical Neuroanatomy Research & Education Center, Capital Medical University Xuanwu Hospital, China International Neuroscience Institute (China-INI), Beijing, China
| | - Xu Wang
- Department of Neurosurgery, Samii Clinical Neuroanatomy Research & Education Center, Capital Medical University Xuanwu Hospital, China International Neuroscience Institute (China-INI), Beijing, China
| | - Xiaohai Liu
- Department of Neurosurgery, Samii Clinical Neuroanatomy Research & Education Center, Capital Medical University Xuanwu Hospital, China International Neuroscience Institute (China-INI), Beijing, China
| | - Jiantao Liang
- Department of Neurosurgery, Samii Clinical Neuroanatomy Research & Education Center, Capital Medical University Xuanwu Hospital, China International Neuroscience Institute (China-INI), Beijing, China
| | - Ge Chen
- Department of Neurosurgery, Samii Clinical Neuroanatomy Research & Education Center, Capital Medical University Xuanwu Hospital, China International Neuroscience Institute (China-INI), Beijing, China
| | - Yuanjing Feng
- Institute of Information Processing and Automation, College of Information Engineering, Zhejiang University of Technology, Hangzhou, China
| | - Mingchu Li
- Department of Neurosurgery, Samii Clinical Neuroanatomy Research & Education Center, Capital Medical University Xuanwu Hospital, China International Neuroscience Institute (China-INI), Beijing, China
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11
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Shi L, Fan S, Yuan T, Fang H, Zheng J, Xiao Z, Diao Y, Zhu G, Zhang Q, Liu H, Zhang H, Meng F, Zhang J, Yang A. Microstimulation Is a Promising Approach in Achieving Better Lead Placement in Subthalamic Nucleus Deep Brain Stimulation Surgery. Front Neurol 2021; 12:683532. [PMID: 34630273 PMCID: PMC8493285 DOI: 10.3389/fneur.2021.683532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 08/16/2021] [Indexed: 11/24/2022] Open
Abstract
Background: The successful application of subthalamic nucleus (STN) deep brain stimulation (DBS) surgery relies mostly on optimal lead placement, whereas the major challenge is how to precisely localize STN. Microstimulation, which can induce differentiating inhibitory responses between STN and substantia nigra pars reticulata (SNr) near the ventral border of STN, has indicated a great potential of breaking through this barrier. Objective: This study aims to investigate the feasibility of localizing the boundary between STN and SNr (SSB) using microstimulation and promote better lead placement. Methods: We recorded neurophysiological data from 41 patients undergoing STN-DBS surgery with microstimulation in our hospital. Trajectories with typical STN signal were included. Microstimulation was applied near the bottom of STN to determine SSB, which was validated by the imaging reconstruction of DBS leads. Results: In most trajectories with microstimulation (84.4%), neuronal firing in STN could not be inhibited by microstimulation, whereas in SNr long inhibition was observed following microstimulation. The success rate of localizing SSB was significantly higher in trajectories with microstimulation than those without. Moreover, results from imaging reconstruction and intraoperative neurological assessments demonstrated better lead location and higher therapeutic effectiveness in trajectories with microstimulation and accurately identified SSB. Conclusion: Microstimulation on microelectrode recording is an effective approach to localize the SSB. Our data provide clinical evidence that microstimulation can be routinely employed to achieve better lead placement.
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Affiliation(s)
- Lin Shi
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Beijing, China
| | - Shiying Fan
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Tianshuo Yuan
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Huaying Fang
- Beijing Advanced Innovation Center for Imaging Theory and Technology, Capital Normal University, Beijing, China
- Academy for Multidisciplinary Studies, Capital Normal University, Beijing, China
| | - Jie Zheng
- Department of Ophthalmology, Children's Hospital, Harvard Medical School, Boston, MA, United States
| | - Zunyu Xiao
- Molecular Imaging Research Center, Harbin Medical University, Harbin, China
| | - Yu Diao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Guanyu Zhu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Quan Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Huanguang Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hua Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Fangang Meng
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Beijing, China
| | - Jianguo Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Beijing, China
| | - Anchao Yang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Beijing, China
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12
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Li M, Ribas EC, Zhang Z, Wu X, Wang X, Liu X, Liang J, Chen G, Li M. Tractography of the ansa lenticularis in the human brain. Clin Anat 2021; 35:269-279. [PMID: 34535922 DOI: 10.1002/ca.23788] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 09/02/2021] [Accepted: 09/08/2021] [Indexed: 12/31/2022]
Abstract
The aim of this study was to make a thorough investigation of the trajectory of the ansa lenticularis (AL) and its subcomponents using high-resolution fiber-tracking tractography. The subcomponents of the AL were reconstructed from one region of interest (ROI) in the area of the globus pallidus combined with another ROI in the red nucleus, substantia nigra, subthalamic nucleus, or thalamus. This fiber-tracking protocol was tested in an HCP-1065 template, 35 healthy subjects from Massachusetts General Hospital (MGH), and 20 healthy subjects from the human connectome project (HCP) using generalized q-sampling imaging (GQI)-based tractography. Quantitative anisotropy and fractional anisotropy were also computed for the AL subcomponents. The subcomponents of the AL could be reconstructed in the HCP-1065 template, 35 MGH healthy subjects, and 20 HCP healthy subjects. The AL descends from the globus pallidus and joins the ansa peduncularis for a short distance, subdividing later into fibers that continue separately to the red nucleus, substantia nigra, subthalamic nucleus, and thalamus. The study demonstrated the trajectory of the ansa lenticularis and its subcomponents using GQI-based tractography, improving our understanding of the anatomical connectivity between the globus pallidus and the thalamo-subthalamic region in the human brain. One Sentence Summary The investigation of the ansa lenticularis and its subcomponents using high-resolution diffusion images based tractography.
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Affiliation(s)
- Mengjun Li
- Department of Neurosurgery, Samii Clinical Neuroanatomy Research & Education Center, Capital Medical University Xuanwu Hospital, China International Neuroscience Institute (China-INI), Beijing, China
| | - Eduardo Carvalhal Ribas
- Division of Neurosurgery, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Zhiping Zhang
- Department of Neurosurgery, Samii Clinical Neuroanatomy Research & Education Center, Capital Medical University Xuanwu Hospital, China International Neuroscience Institute (China-INI), Beijing, China
| | - Xiaolong Wu
- Department of Neurosurgery, Samii Clinical Neuroanatomy Research & Education Center, Capital Medical University Xuanwu Hospital, China International Neuroscience Institute (China-INI), Beijing, China
| | - Xu Wang
- Department of Neurosurgery, Samii Clinical Neuroanatomy Research & Education Center, Capital Medical University Xuanwu Hospital, China International Neuroscience Institute (China-INI), Beijing, China
| | - Xiaohai Liu
- Department of Neurosurgery, Samii Clinical Neuroanatomy Research & Education Center, Capital Medical University Xuanwu Hospital, China International Neuroscience Institute (China-INI), Beijing, China
| | - Jiantao Liang
- Department of Neurosurgery, Samii Clinical Neuroanatomy Research & Education Center, Capital Medical University Xuanwu Hospital, China International Neuroscience Institute (China-INI), Beijing, China
| | - Ge Chen
- Department of Neurosurgery, Samii Clinical Neuroanatomy Research & Education Center, Capital Medical University Xuanwu Hospital, China International Neuroscience Institute (China-INI), Beijing, China
| | - Mingchu Li
- Department of Neurosurgery, Samii Clinical Neuroanatomy Research & Education Center, Capital Medical University Xuanwu Hospital, China International Neuroscience Institute (China-INI), Beijing, China
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Ehlen F, Al-Fatly B, Kühn AA, Klostermann F. Impact of deep brain stimulation of the subthalamic nucleus on natural language in patients with Parkinson's disease. PLoS One 2020; 15:e0244148. [PMID: 33373418 PMCID: PMC7771859 DOI: 10.1371/journal.pone.0244148] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 12/03/2020] [Indexed: 12/30/2022] Open
Abstract
Background In addition to the typical motor symptoms, a majority of patients suffering from Parkinson’s disease experience language impairments. Deep Brain Stimulation of the subthalamic nucleus robustly reduces motor dysfunction, but its impact on language skills remains ambiguous. Method To elucidate the impact of subthalamic deep brain stimulation on natural language production, we systematically analyzed language samples from fourteen individuals (three female / eleven male, average age 66.43 ± 7.53 years) with Parkinson’s disease in the active (ON) versus inactive (OFF) stimulation condition. Significant ON-OFF differences were considered as stimulation effects. To localize their neuroanatomical origin within the subthalamic nucleus, they were correlated with the volume of tissue activated by therapeutic stimulation. Results Word and clause production speed increased significantly under active stimulation. These enhancements correlated with the volume of tissue activated within the associative part of the subthalamic nucleus, but not with that within the dorsolateral motor part, which again correlated with motor improvement. Language error rates were lower in the ON vs. OFF condition, but did not correlate with electrode localization. No significant changes in further semantic or syntactic language features were detected in the current study. Conclusion The findings point towards a facilitation of executive language functions occurring rather independently from motor improvement. Given the presumed origin of this stimulation effect within the associative part of the subthalamic nucleus, this could be due to co-stimulation of the prefrontal-subthalamic circuit.
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Affiliation(s)
- Felicitas Ehlen
- Department of Neurology, Humboldt-Universität zu Berlin and Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Department of Psychiatry and Psychotherapy, Jüdisches Krankenhaus Berlin, Berlin, Germany
- * E-mail:
| | - Bassam Al-Fatly
- Department of Neurology, Humboldt-Universität zu Berlin and Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Andrea A. Kühn
- Department of Neurology, Humboldt-Universität zu Berlin and Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany
- Neurocure Cluster of Excellence, Humboldt-Universität zu Berlin and Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Bernstein Center for Computational Neuroscience, Humboldt-Universität zu Berlin and Berlin Institute of Health, Charité—Universitätsmedizin Berlin, Berlin, Germany
- Deutsches Zentrum für Neurodegenerative Erkrankungen, Berlin, Germany
| | - Fabian Klostermann
- Department of Neurology, Humboldt-Universität zu Berlin and Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany
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14
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Dziedzic TA, Balasa A, Jeżewski MP, Michałowski Ł, Marchel A. White matter dissection with the Klingler technique: a literature review. Brain Struct Funct 2020; 226:13-47. [PMID: 33165658 PMCID: PMC7817571 DOI: 10.1007/s00429-020-02157-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 10/13/2020] [Indexed: 12/21/2022]
Abstract
The aim of this literature review is to present a summary of the published literature relating the details of the different modifications of specimen preparation for white matter dissection with the Klingler technique. For this review, 3 independent investigators performed an electronic literature search that was carried out in the Pubmed, Scopus and Web of Science databses up to December 2019. Furthermore, we performed citation tracking for the articles missed in the initial search. Studies were eligible for inclusion when they reported details of at least the first 2 main steps of Klingler's technique: fixation and freezing. A total of 37 full-text articles were included in the analysis. We included original anatomical studies in which human white matter dissection was performed for study purposes. The main three steps of preparation are the same in each laboratory, but the details of each vary between studies. Ten percent formalin is the most commonly used (34 studies) solution for fixation. The freezing time varied between 8 h and a month, and the temperature varied from - 5 to - 80 °C. After thawing and during dissections, the specimens were most often kept in formalin solution (13), and the concentration varied from 4 to 10%. Klingler's preparation technique involves three main steps: fixation, freezing and thawing. Even though the details of the technique are different in most of the studies, all provide subjectively good quality specimens for anatomical dissections and studies.
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Affiliation(s)
- Tomasz A Dziedzic
- Department of Neurosurgery, Medical University of Warsaw, Warsaw, Poland.
| | - Artur Balasa
- Department of Neurosurgery, Medical University of Warsaw, Warsaw, Poland
| | - Mateusz P Jeżewski
- Department of Neurosurgery, Medical University of Warsaw, Warsaw, Poland
| | | | - Andrzej Marchel
- Department of Neurosurgery, Medical University of Warsaw, Warsaw, Poland
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15
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Bao L, Xiong C, Wei W, Chen Z, van Zijl PCM, Li X. Diffusion-regularized susceptibility tensor imaging (DRSTI) of tissue microstructures in the human brain. Med Image Anal 2020; 67:101827. [PMID: 33166777 DOI: 10.1016/j.media.2020.101827] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Revised: 08/19/2020] [Accepted: 08/31/2020] [Indexed: 10/23/2022]
Abstract
Susceptibility tensor imaging (STI) has been proposed as an alternative to diffusion tensor imaging (DTI) for non-invasive in vivo characterization of brain tissue microstructure and white matter fiber architecture, potentially benefitting from its high spatial resolution. In spite of different biophysical mechanisms, animal studies have demonstrated white matter fiber directions measured using STI to be reasonably consistent with those from diffusion tensor imaging (DTI). However, human brain STI is hampered by its requirement of acquiring data at more than 10 head rotations and a complicated processing pipeline. In this paper, we propose a diffusion-regularized STI method (DRSTI) that employs a tensor spectral decomposition constraint to regularize the STI solution using the fiber directions estimated by DTI as a priori. We then explore the high-resolution DRSTI with MR phase images acquired at only 6 head orientations. Compared to other STI approaches, the DRSTI generated susceptibility tensor components, mean magnetic susceptibility (MMS), magnetic susceptibility anisotropy (MSA) and fiber direction maps with fewer artifacts, especially in regions with large susceptibility variations, and with less erroneous quantifications. In addition, the DRSTI method allows us to distinguish more structural features that could not be identified in DTI, especially in deep gray matters. DRSTI enables a more accurate susceptibility tensor estimation with a reduced number of sampling orientations, and achieves better tracking of fiber pathways than previous STI attempts on in vivo human brain.
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Affiliation(s)
- Lijun Bao
- Department of Electronic Science, Fujian Provincial Key Laboratory of Plasma and Magnetic Resonance, Xiamen University, Xiamen 361000, China.
| | - Congcong Xiong
- Department of Electronic Science, Fujian Provincial Key Laboratory of Plasma and Magnetic Resonance, Xiamen University, Xiamen 361000, China
| | - Wenping Wei
- Medical Imaging Diagnostic Center, First Affiliated Hospital of Xiamen University, Xiamen 361000, China
| | - Zhong Chen
- Department of Electronic Science, Fujian Provincial Key Laboratory of Plasma and Magnetic Resonance, Xiamen University, Xiamen 361000, China
| | - Peter C M van Zijl
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD 21205, USA
| | - Xu Li
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD 21205, USA
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The ansa peduncularis in the human brain: A tractography and fiber dissection study. Brain Res 2020; 1746:146978. [PMID: 32535175 DOI: 10.1016/j.brainres.2020.146978] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 06/08/2020] [Accepted: 06/09/2020] [Indexed: 11/21/2022]
Abstract
INTRODUCTION The ansa peduncularis is a composite of white matter fiber bundles closely packed together that sweeps around the cerebral peduncle. The exact components of the ansa peduncularis and their anatomical trajectories are still not established firmly in the literature. OBJECTIVE The aim of this study was to examine the topographical anatomy of the ansa peduncularis and its subcomponents using the fiber dissection and tractography techniques. METHODS Ten formalin-fixed brains were prepared according to Klingler's method and dissected by the fiber dissection technique from the lateral, medial and inferior surfaces. The ansa peduncularis was also traced using high definition fiber tracking (HDFT) from the MRI data of twenty healthy adults and a 1021-subject template from the Human Connectome Project. RESULTS The ventral amygdalofugal pathway system includes white matter fiber bundles with a topographically close relation as they sweep around the cerebral peduncle and contribute to form the ansa peduncularis: amygdaloseptal fibers connect the amygdala and anterior temporal cortex to the septal region and amygdalohypothalamic fibers project from the amygdala to the hypothalamus. Additionally, from the amygdala and anterior temporal cortex, amygdalothalamic fibers project to the medial thalamic region. The ansa lenticularis, which connects the globus pallidus to the thalamus, was not shown in our study. CONCLUSION The study demonstrated the trajectory of the ansa peduncularis and its subcomponents, based on fiber dissection and tractography, improving our understanding of human brain anatomical connectivity.
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Vassal F, Dilly D, Boutet C, Bertholon F, Charier D, Pommier B. White matter tracts involved by deep brain stimulation of the subthalamic nucleus in Parkinson's disease: a connectivity study based on preoperative diffusion tensor imaging tractography. Br J Neurosurg 2019; 34:187-195. [PMID: 31833430 DOI: 10.1080/02688697.2019.1701630] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Purpose: To depict the specific brain networks that are modulated by deep brain stimulation (DBS) of the subthalamic nucleus (STN) in Parkinson's disease (PD), using diffusion tensor imaging-based fibre tractography (DTI-FT).Materials and methods: Nine patients who received bilateral STN-DBS for PD were included. Electrodes were localized by co-registering preoperative magnetic resonance imaging and postoperative computed tomography. The volume of tissue activated (VTA) was estimated as an isotropic, spherical electric field distribution centred at each effective electrode contact's centroid coordinates, taking into account individual stimulation parameters (i.e. voltage, impedance). Brain connectivity analysis was undertaken using a deterministic DTI-FT method, seeded from a single region of interest corresponding to the VTA. The labelling of the reconstructed white matter fibre tracts relied on their path and (sub)cortical termination territories.Results: Six months after surgery, we observed a statistically significant reduction in both the Unified Parkinson Disease Rating Scale part III and L-dopa equivalent daily dose. Areas consistently connected to the VTA included the brainstem (100%), cerebellum (94%), dorsal (i.e. supplementary motor area) and lateral premotor cortex (94%), and primary motor cortex (72%). An involvement of the hyperdirect pathway (HDP) connecting the STN and the (pre)motor cortex was demonstrated.Conclusions: The connectivity patterns observed in this study suggest that the therapeutic effects of STN-DBS are mediated through the modulation of distributed, large-scale motor networks. Specifically, the depiction of projection neurons connecting the stimulated area/STN to the (pre)motor cortex, reinforce the growing evidence that the HDP might be a potential therapeutic target in PD. If further replicated, these findings could raise the possibility that DTI-FT reconstruction of the HDP may critically improve DBS targeting and stimulation parameters selection, through the development of programming tools that incorporate VTA modelling and patient-specific DTI-FT data.
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Affiliation(s)
- François Vassal
- Department of Neurosurgery, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Domitille Dilly
- Department of Neurology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Claire Boutet
- Department of Neuroradiology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Frédérique Bertholon
- Department of Clinical Neurophysiology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - David Charier
- Department of Anesthesiology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Benjamin Pommier
- Department of Neurosurgery, University Hospital of Saint-Etienne, Saint-Etienne, France
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Koeglsperger T, Palleis C, Hell F, Mehrkens JH, Bötzel K. Deep Brain Stimulation Programming for Movement Disorders: Current Concepts and Evidence-Based Strategies. Front Neurol 2019; 10:410. [PMID: 31231293 PMCID: PMC6558426 DOI: 10.3389/fneur.2019.00410] [Citation(s) in RCA: 114] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 04/04/2019] [Indexed: 11/16/2022] Open
Abstract
Deep brain stimulation (DBS) has become the treatment of choice for advanced stages of Parkinson's disease, medically intractable essential tremor, and complicated segmental and generalized dystonia. In addition to accurate electrode placement in the target area, effective programming of DBS devices is considered the most important factor for the individual outcome after DBS. Programming of the implanted pulse generator (IPG) is the only modifiable factor once DBS leads have been implanted and it becomes even more relevant in cases in which the electrodes are located at the border of the intended target structure and when side effects become challenging. At present, adjusting stimulation parameters depends to a large extent on personal experience. Based on a comprehensive literature search, we here summarize previous studies that examined the significance of distinct stimulation strategies for ameliorating disease signs and symptoms. We assess the effect of adjusting the stimulus amplitude (A), frequency (f), and pulse width (pw) on clinical symptoms and examine more recent techniques for modulating neuronal elements by electrical stimulation, such as interleaving (Medtronic®) or directional current steering (Boston Scientific®, Abbott®). We thus provide an evidence-based strategy for achieving the best clinical effect with different disorders and avoiding adverse effects in DBS of the subthalamic nucleus (STN), the ventro-intermedius nucleus (VIM), and the globus pallidus internus (GPi).
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Affiliation(s)
- Thomas Koeglsperger
- Department of Neurology, Ludwig Maximilians University, Munich, Germany.,Department of Translational Neurodegeneration, German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
| | - Carla Palleis
- Department of Neurology, Ludwig Maximilians University, Munich, Germany.,Department of Translational Neurodegeneration, German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
| | - Franz Hell
- Department of Neurology, Ludwig Maximilians University, Munich, Germany.,Graduate School of Systemic Neurosciences, Ludwig-Maximilians-Universität München, Martinsried, Germany
| | - Jan H Mehrkens
- Department of Neurosurgery, Ludwig Maximilians University, Munich, Germany
| | - Kai Bötzel
- Department of Neurology, Ludwig Maximilians University, Munich, Germany
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Hell F, Palleis C, Mehrkens JH, Koeglsperger T, Bötzel K. Deep Brain Stimulation Programming 2.0: Future Perspectives for Target Identification and Adaptive Closed Loop Stimulation. Front Neurol 2019; 10:314. [PMID: 31001196 PMCID: PMC6456744 DOI: 10.3389/fneur.2019.00314] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 03/12/2019] [Indexed: 12/28/2022] Open
Abstract
Deep brain stimulation has developed into an established treatment for movement disorders and is being actively investigated for numerous other neurological as well as psychiatric disorders. An accurate electrode placement in the target area and the effective programming of DBS devices are considered the most important factors for the individual outcome. Recent research in humans highlights the relevance of widespread networks connected to specific DBS targets. Improving the targeting of anatomical and functional networks involved in the generation of pathological neural activity will improve the clinical DBS effect and limit side-effects. Here, we offer a comprehensive overview over the latest research on target structures and targeting strategies in DBS. In addition, we provide a detailed synopsis of novel technologies that will support DBS programming and parameter selection in the future, with a particular focus on closed-loop stimulation and associated biofeedback signals.
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Affiliation(s)
- Franz Hell
- Department of Neurology, Ludwig Maximilians University, Munich, Germany
- Graduate School of Systemic Neurosciences, Ludwig Maximilians University, Munich, Germany
| | - Carla Palleis
- Department of Neurology, Ludwig Maximilians University, Munich, Germany
- Department of Translational Neurodegeneration, German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
| | - Jan H. Mehrkens
- Department of Neurosurgery, Ludwig Maximilians University, Munich, Germany
| | - Thomas Koeglsperger
- Department of Neurology, Ludwig Maximilians University, Munich, Germany
- Department of Translational Neurodegeneration, German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
| | - Kai Bötzel
- Department of Neurology, Ludwig Maximilians University, Munich, Germany
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