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A role of diffusion tensor imaging in movement disorder surgery.

Barkhoudarian G, Klochkov T, Sedrak M, Frew A, Gorgulho A, Behnke E, De Salles A - Acta Neurochir (Wien) (2010)

Bottom Line: Fundamental understanding of individual patient's anatomy is critical for optimizing the effects and side effects of DBS surgery.This represents a possible mechanism of the increased effects and side effects observed with higher stimulation voltages.Currently available diffusion tensor imaging techniques allow potential methods to characterize the effects and side effects of DBS.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, University of California Los Angeles, 90095-7039, USA. gbarkhoudarian@mednet.ucla.edu

ABSTRACT
The safe and reversible nature of deep brain stimulation (DBS) has allowed movement disorder neurosurgery to become commonplace throughout the world. Fundamental understanding of individual patient's anatomy is critical for optimizing the effects and side effects of DBS surgery. Three patients undergoing stereotactic surgery for movement disorders, at the institution's intraoperative magnetic resonance imaging operating suite, were studied with fiber tractography. Stereotactic targets and fiber tractography were determined on preoperative magnetic resonance imagings using the Schaltenbrand-Wahren atlas for definition in the BrainLab iPlan software (BrainLAB Inc., Feldkirchen, Germany). Subthalamic nucleus, globus pallidus interna, and ventral intermediate nucleus targets were studied. Diffusion tensor imaging parameters used ranged from 2 to 8 mm for volume of interest in the x/y/z planes, fiber length was kept constant at 30 mm, and fractional anisotropy threshold varied from 0.20 to 0.45. Diffusion tensor imaging tractography allowed reliable and reproducible visualization and correlation between frontal eye field, premotor, primary motor, and primary sensory cortices via corticospinal tracts and corticopontocerebellar tracts. There is an apparent increase in the number of cortical regions targeted by the fiber tracts as the region of interest is enlarged. This represents a possible mechanism of the increased effects and side effects observed with higher stimulation voltages. Currently available diffusion tensor imaging techniques allow potential methods to characterize the effects and side effects of DBS. This technology has the potential of being a powerful tool to optimize DBS neurosurgery.

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a Diagram of the Medtronic 3389 intracranial DBS lead orientation and measurements. b Color-coded diagram of ROI voxels used for fiber tractography at specific locations surrounding the case electrode lead. The yellow boxes demonstrate the 2 × 2 × 2 mm small ROIs. The purple boxes demonstrate the total of 2 × 2 × 8 mm large ROI (including the original 2 × 2 × 2 mm ROI). Fiber tractography demonstrated in Figs. 3–5 adhere to this color scheme
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Fig1: a Diagram of the Medtronic 3389 intracranial DBS lead orientation and measurements. b Color-coded diagram of ROI voxels used for fiber tractography at specific locations surrounding the case electrode lead. The yellow boxes demonstrate the 2 × 2 × 2 mm small ROIs. The purple boxes demonstrate the total of 2 × 2 × 8 mm large ROI (including the original 2 × 2 × 2 mm ROI). Fiber tractography demonstrated in Figs. 3–5 adhere to this color scheme

Mentions: Patient 1 underwent DBS of the STN for Parkinson disease treatment. Fiber tractography was performed at right lead 1 (Fig. 1a) where improvement in motor function was seen at 1.5 V. The threshold for uncontrollable arm movement was noted at 3.4 V. Final coordinates for the tip of the electrode were 10.6 mm lateral to the AC/PC line, 1.6 mm posterior to the AC/PC midcommisural plane, and 3.6 mm ventral to AC/PC plane.Fig. 1


A role of diffusion tensor imaging in movement disorder surgery.

Barkhoudarian G, Klochkov T, Sedrak M, Frew A, Gorgulho A, Behnke E, De Salles A - Acta Neurochir (Wien) (2010)

a Diagram of the Medtronic 3389 intracranial DBS lead orientation and measurements. b Color-coded diagram of ROI voxels used for fiber tractography at specific locations surrounding the case electrode lead. The yellow boxes demonstrate the 2 × 2 × 2 mm small ROIs. The purple boxes demonstrate the total of 2 × 2 × 8 mm large ROI (including the original 2 × 2 × 2 mm ROI). Fiber tractography demonstrated in Figs. 3–5 adhere to this color scheme
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2991222&req=5

Fig1: a Diagram of the Medtronic 3389 intracranial DBS lead orientation and measurements. b Color-coded diagram of ROI voxels used for fiber tractography at specific locations surrounding the case electrode lead. The yellow boxes demonstrate the 2 × 2 × 2 mm small ROIs. The purple boxes demonstrate the total of 2 × 2 × 8 mm large ROI (including the original 2 × 2 × 2 mm ROI). Fiber tractography demonstrated in Figs. 3–5 adhere to this color scheme
Mentions: Patient 1 underwent DBS of the STN for Parkinson disease treatment. Fiber tractography was performed at right lead 1 (Fig. 1a) where improvement in motor function was seen at 1.5 V. The threshold for uncontrollable arm movement was noted at 3.4 V. Final coordinates for the tip of the electrode were 10.6 mm lateral to the AC/PC line, 1.6 mm posterior to the AC/PC midcommisural plane, and 3.6 mm ventral to AC/PC plane.Fig. 1

Bottom Line: Fundamental understanding of individual patient's anatomy is critical for optimizing the effects and side effects of DBS surgery.This represents a possible mechanism of the increased effects and side effects observed with higher stimulation voltages.Currently available diffusion tensor imaging techniques allow potential methods to characterize the effects and side effects of DBS.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, University of California Los Angeles, 90095-7039, USA. gbarkhoudarian@mednet.ucla.edu

ABSTRACT
The safe and reversible nature of deep brain stimulation (DBS) has allowed movement disorder neurosurgery to become commonplace throughout the world. Fundamental understanding of individual patient's anatomy is critical for optimizing the effects and side effects of DBS surgery. Three patients undergoing stereotactic surgery for movement disorders, at the institution's intraoperative magnetic resonance imaging operating suite, were studied with fiber tractography. Stereotactic targets and fiber tractography were determined on preoperative magnetic resonance imagings using the Schaltenbrand-Wahren atlas for definition in the BrainLab iPlan software (BrainLAB Inc., Feldkirchen, Germany). Subthalamic nucleus, globus pallidus interna, and ventral intermediate nucleus targets were studied. Diffusion tensor imaging parameters used ranged from 2 to 8 mm for volume of interest in the x/y/z planes, fiber length was kept constant at 30 mm, and fractional anisotropy threshold varied from 0.20 to 0.45. Diffusion tensor imaging tractography allowed reliable and reproducible visualization and correlation between frontal eye field, premotor, primary motor, and primary sensory cortices via corticospinal tracts and corticopontocerebellar tracts. There is an apparent increase in the number of cortical regions targeted by the fiber tracts as the region of interest is enlarged. This represents a possible mechanism of the increased effects and side effects observed with higher stimulation voltages. Currently available diffusion tensor imaging techniques allow potential methods to characterize the effects and side effects of DBS. This technology has the potential of being a powerful tool to optimize DBS neurosurgery.

Show MeSH
Related in: MedlinePlus