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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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Related in: MedlinePlus

Three-dimensional demonstration of fiber tractography with STN, VIM, and GPi targets in anteroposterior (a), craniocaudal (b), and lateral (c) views. The ROI was a 4-mm cube centered around the targets as calculated from the AC/PC coordinates. There is significant variability in fiber tract targets, particularly between GPi and STN DBS targets
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Fig2: Three-dimensional demonstration of fiber tractography with STN, VIM, and GPi targets in anteroposterior (a), craniocaudal (b), and lateral (c) views. The ROI was a 4-mm cube centered around the targets as calculated from the AC/PC coordinates. There is significant variability in fiber tract targets, particularly between GPi and STN DBS targets

Mentions: Fiber tractography demonstrates that, globally, the majority of fiber tracts were medial to GPi, lateral to VIM, and encased in STN. This correlates to known anatomically defined pathways of the internal capsule and the corona radiata. There were varying pathways seen as the region of interest (ROI) was expanded. This is demonstrated with three-dimensional rendition of hemispheric fiber tractography per each DBS target (Fig. 2). Notice the broader spread of fibers passing in proximity of the GPi target (yellow) as compared with STN (pink) and mostly to the specific focallity of the fibers en passage close to the VIM target.Fig. 2


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)

Three-dimensional demonstration of fiber tractography with STN, VIM, and GPi targets in anteroposterior (a), craniocaudal (b), and lateral (c) views. The ROI was a 4-mm cube centered around the targets as calculated from the AC/PC coordinates. There is significant variability in fiber tract targets, particularly between GPi and STN DBS targets
© Copyright Policy
Related In: Results  -  Collection

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

Fig2: Three-dimensional demonstration of fiber tractography with STN, VIM, and GPi targets in anteroposterior (a), craniocaudal (b), and lateral (c) views. The ROI was a 4-mm cube centered around the targets as calculated from the AC/PC coordinates. There is significant variability in fiber tract targets, particularly between GPi and STN DBS targets
Mentions: Fiber tractography demonstrates that, globally, the majority of fiber tracts were medial to GPi, lateral to VIM, and encased in STN. This correlates to known anatomically defined pathways of the internal capsule and the corona radiata. There were varying pathways seen as the region of interest (ROI) was expanded. This is demonstrated with three-dimensional rendition of hemispheric fiber tractography per each DBS target (Fig. 2). Notice the broader spread of fibers passing in proximity of the GPi target (yellow) as compared with STN (pink) and mostly to the specific focallity of the fibers en passage close to the VIM target.Fig. 2

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