A three-dimensional histological atlas of the human basal ganglia. II. Atlas deformation strategy and evaluation in deep brain stimulation for Parkinson disease

2009 ◽  
Vol 110 (2) ◽  
pp. 208-219 ◽  
Author(s):  
Eric Bardinet ◽  
Manik Bhattacharjee ◽  
Didier Dormont ◽  
Bernard Pidoux ◽  
Grégoire Malandain ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Basal Ganglia ◽  
Parkinson Disease ◽  
Brain Stimulation ◽  
Magnetic Resonance Images ◽  
Mr Images ◽  
Registration Method ◽  
Automated Method ◽  
The Brain ◽  
Deep Brain

Object The localization of any given target in the brain has become a challenging issue because of the increased use of deep brain stimulation to treat Parkinson disease, dystonia, and nonmotor diseases (for example, Tourette syndrome, obsessive compulsive disorders, and depression). The aim of this study was to develop an automated method of adapting an atlas of the human basal ganglia to the brains of individual patients. Methods Magnetic resonance images of the brain specimen were obtained before extraction from the skull and histological processing. Adaptation of the atlas to individual patient anatomy was performed by reshaping the atlas MR images to the images obtained in the individual patient using a hierarchical registration applied to a region of interest centered on the basal ganglia, and then applying the reshaping matrix to the atlas surfaces. Results Results were evaluated by direct visual inspection of the structures visible on MR images and atlas anatomy, by comparison with electrophysiological intraoperative data, and with previous atlas studies in patients with Parkinson disease. The method was both robust and accurate, never failing to provide an anatomically reliable atlas to patient registration. The registration obtained did not exceed a 1-mm mismatch with the electrophysiological signatures in the region of the subthalamic nucleus. Conclusions This registration method applied to the basal ganglia atlas forms a powerful and reliable method for determining deep brain stimulation targets within the basal ganglia of individual patients.

Brain shift: an error factor during implantation of deep brain stimulation electrodes

2007 ◽  
Vol 107 (5) ◽  
pp. 989-997 ◽  
Author(s):  
Yasushi Miyagi ◽  
Fumio Shima ◽  
Tomio Sasaki
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Brain Shift ◽  
Mr Images ◽  
Implanted Electrodes ◽  
Error Factor ◽  
Bilateral Surgery ◽  
Second Procedure ◽  
The Brain ◽  
Deep Brain

Object The goal of this study was to focus on the tendency of brain shift during stereotactic neurosurgery and the shift's impact on the unilateral and bilateral implantation of electrodes for deep brain stimulation (DBS). Methods Eight unilateral and 10 bilateral DBS electrodes at 10 nuclei ventrales intermedii and 18 subthalamic nuclei were implanted in patients at Kaizuka Hospital with the aid of magnetic resonance (MR) imaging–guided and microelectrode-guided methods. Brain shift was assessed as changes in the 3D coordinates of the anterior and posterior commissures (AC and PC) with MR images before and immediately after the implantation surgery. The positions of the implanted electrodes, based on the midcommissural point and AC–PC line, were measured both on x-ray films (virtual position) during surgery and the postoperative MR images (actual position) obtained on the 7th day postoperatively. Results Contralateral and posterior shift of the AC and PC were the characteristics of unilateral and bilateral procedures, respectively. The authors suggest the following. 1) The first unilateral procedure elicits a unilateral air invasion, resulting in a contralateral brain shift. 2) During the second procedure in the bilateral surgery, the contralateral shift is reset to the midline and, at the same time, the anteroposterior support by the contralateral hemisphere against gravity is lost due to a bilateral air invasion, resulting in a significant posterior (caudal) shift. Conclusions To note the tendency of the brain to shift is very important for accurate implantation of a DBS electrode or high frequency thermocoagulation, as well as for the prediction of therapeutic and adverse effects of stereotactic surgery.

scholarly journals Research-Based Updates in Swallowing and Communication Dysfunction in Parkinson Disease: Implications for Evaluation and Management

2019 ◽  
Vol 4 (5) ◽  
pp. 825-841 ◽  
Author(s):  
C. K. Broadfoot ◽  
D. Abur ◽  
J. D. Hoffmeister ◽  
C. E. Stepp ◽  
M. R. Ciucci
Keyword(s):  
Quality Of Life ◽  
Deep Brain Stimulation ◽  
Basal Ganglia ◽  
Parkinson Disease ◽  
Brain Stimulation ◽  
Dopaminergic Medication ◽  
Symptom Evaluation ◽  
Neurophysiological Basis ◽  
Deep Brain

Purpose Individuals with Parkinson disease (PD) present with complex and variable symptoms, with recent findings suggesting that the etiology of PD extends beyond the involvement of just the basal ganglia. These symptoms include significant impairments in the speech and swallowing domains, which can greatly affect quality of life and therefore require therapeutic attention. This research-based update reviews the neurophysiological basis for swallowing and speech changes in PD, the effectiveness of various types of treatments, and the implications for symptom evaluation and management. Conclusion The mechanisms responsible for swallowing and speech symptoms in PD remain largely unknown. Dopaminergic medication and deep brain stimulation do not provide consistent benefits for these symptoms, suggesting a nondopaminergic network is involved. Importantly, evidence suggests that symptoms of dysphagia and hypokinetic dysarthria may be early indications of PD, so it is critical to investigate the cause of these changes.

scholarly journals Fiber tractography of the axonal pathways linking the basal ganglia and cerebellum in Parkinson disease: implications for targeting in deep brain stimulation

2014 ◽  
Vol 120 (4) ◽  
pp. 988-996 ◽  
Author(s):  
Jennifer A. Sweet ◽  
Benjamin L. Walter ◽  
Kabilar Gunalan ◽  
Ashutosh Chaturvedi ◽  
Cameron C. McIntyre ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
White Matter ◽  
Basal Ganglia ◽  
Parkinson Disease ◽  
Brain Stimulation ◽  
Cerebellar Hemisphere ◽  
Therapeutic Effects ◽  
Fiber Tractography ◽  
The Mean ◽  
Deep Brain

Object Stimulation of white matter pathways near targeted structures may contribute to therapeutic effects of deep brain stimulation (DBS) for patients with Parkinson disease (PD). Two tracts linking the basal ganglia and cerebellum have been described in primates: the subthalamopontocerebellar tract (SPCT) and the dentatothalamic tract (DTT). The authors used fiber tractography to evaluate white matter tracts that connect the cerebellum to the region of the basal ganglia in patients with PD who were candidates for DBS. Methods Fourteen patients with advanced PD underwent 3-T MRI, including 30-directional diffusion-weighted imaging sequences. Diffusion tensor tractography was performed using 2 regions of interest: ipsilateral subthalamic and red nuclei, and contralateral cerebellar hemisphere. Nine patients underwent subthalamic DBS, and the course of each tract was observed relative to the location of the most effective stimulation contact and the volume of tissue activated. Results In all patients 2 distinct tracts were identified that corresponded closely to the described anatomical features of the SPCT and DTT, respectively. The mean overall distance from the active contact to the DTT was 2.18 ± 0.35 mm, and the mean proportional distance relative to the volume of tissue activated was 1.35 ± 0.48. There was a nonsignificant trend toward better postoperative tremor control in patients with electrodes closer to the DTT. Conclusions The SPCT and the DTT may be related to the expression of symptoms in PD, and this may have implications for DBS targeting. The use of tractography to identify the DTT might assist with DBS targeting in the future.

scholarly journals Modulating the human functional connectome using deep brain stimulation

2019 ◽  
Author(s):  
Andreas Horn ◽  
Gregor Wenzel ◽  
Friederike Irmen ◽  
Julius Hübl ◽  
Ningfei Li ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Basal Ganglia ◽  
Human Brain ◽  
Brain Stimulation ◽  
Brain Networks ◽  
Healthy Controls ◽  
Functional Connectome ◽  
Local Impact ◽  
The Brain ◽  
Deep Brain

AbstractNeuroimaging has seen a paradigm shift from a formal description of local activity patterns toward studying distributed brain networks. The recently defined framework of the ‘human connectome’ allows to globally analyse parts of the brain and their interconnections. Deep brain stimulation (DBS) is an invasive therapy for patients with severe movement disorders aiming to retune abnormal brain network activity by local high frequency stimulation of the basal ganglia. Beyond clinical utility, DBS represents a powerful research platform to study functional connectomics and the modulation of distributed brain networks in the human brain. We acquired resting-state functional MRI in twenty Parkinson’s disease (PD) patients with subthalamic DBS switched ON and OFF. An age-matched control cohort of fifteen subjects was acquired from an open data repository. DBS lead placement in the subthalamic nucleus (STN) was localized using a state-of-the art pipeline that involved brain shift correction, multispectral image registration and use of a precise subcortical atlas. Based on a realistic 3D model of the electrode and surrounding anatomy, the amount of local impact of DBS was estimated using a finite element method approach. On a global level, average connectivity increases and decreases throughout the brain were estimated by contrasting ON and OFF DBS scans on a voxel-wise graph comprising eight thousand nodes. Local impact of DBS on the sensorimotor STN explained half the variance in global connectivity increases within the sensorimotor network (R = 0.711, p < 0.001). Moreover, local impact of DBS on the motor STN could explain the degree of how much voxel-wise average brain connectivity normalized toward healthy controls (R = 0.713, p < 0.001). Finally, a network based statistics analysis revealed that DBS attenuated specific couplings that are known to be pathological in PD. Namely, coupling between motor thalamus and sensorimotor cortex was increased and striatal coupling with cerebellum, external pallidum and STN was decreased by DBS.Our results show that rs-fMRI may be acquired in DBS ON and OFF conditions on clinical MRI hardware and that data is useful to gain additional insight into how DBS modulates the functional connectome of the human brain. We demonstrate that effective DBS increases overall connectivity in the motor network, normalizes the network profile toward healthy controls and specifically strengthens thalamo-cortical connectivity while reducing striatal control over basal ganglia and cerebellar structures.

scholarly journals Direct visualization of deep brain stimulation targets in Parkinson disease with the use of 7-tesla magnetic resonance imaging

2010 ◽  
Vol 113 (3) ◽  
pp. 639-647 ◽  
Author(s):  
Zang-Hee Cho ◽  
Hoon-Ki Min ◽  
Se-Hong Oh ◽  
Jae-Yong Han ◽  
Chan-Woong Park ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Mr Imaging ◽  
Parkinson Disease ◽  
Brain Stimulation ◽  
7 Tesla ◽  
Neurosurgical Procedures ◽  
Direct Visualization ◽  
Mr Images ◽  
Internal Globus Pallidus ◽  
Deep Brain

Object A challenge associated with deep brain stimulation (DBS) in treating advanced Parkinson disease (PD) is the direct visualization of brain nuclei, which often involves indirect approximations of stereotactic targets. In the present study, the authors compared T2*-weighted images obtained using 7-T MR imaging with those obtained using 1.5- and 3-T MR imaging to ascertain whether 7-T imaging enables better visualization of targets for DBS in PD. Methods The authors compared 1.5-, 3-, and 7-T MR images obtained in 11 healthy volunteers and 1 patient with PD. Results With 7-T imaging, distinct images of the brain were obtained, including the subthalamic nucleus (STN) and internal globus pallidus (GPi). Compared with the 1.5- and 3-T MR images of the STN and GPi, the 7-T MR images showed marked improvements in spatial resolution, tissue contrast, and signal-to-noise ratio. Conclusions Data in this study reveal the superiority of 7-T MR imaging for visualizing structures targeted for DBS in the management of PD. This finding suggests that by enabling the direct visualization of neural structures of interest, 7-T MR imaging could be a valuable aid in neurosurgical procedures.

scholarly journals A Numerical Study to Compare Stimulations by Intraoperative Microelectrodes and Chronic Macroelectrodes in the DBS Technique

2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
A. Paffi ◽  
F. Apollonio ◽  
M. G. Puxeddu ◽  
M. Parazzini ◽  
G. d’Inzeo ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Basal Ganglia ◽  
Brain Stimulation ◽  
Electric Stimulation ◽  
Numerical Study ◽  
Optimal Parameters ◽  
The Brain ◽  
Correct Target ◽  
Deep Brain ◽  
Stimulation Of

Deep brain stimulation is a clinical technique for the treatment of parkinson’s disease based on the electric stimulation, through an implanted electrode, of specific basal ganglia in the brain. To identify the correct target of stimulation and to choose the optimal parameters for the stimulating signal, intraoperative microelectrodes are generally used. However, when they are replaced with the chronic macroelectrode, the effect of the stimulation is often very different. Here, we used numerical simulations to predict the stimulation of neuronal fibers induced by microelectrodes and macroelectrodes placed in different positions with respect to each other. Results indicate that comparable stimulations can be obtained if the chronic macroelectrode is correctly positioned with the same electric center of the intraoperative microelectrode. Otherwise, some groups of fibers may experience a completely different electric stimulation.

scholarly journals Fully Automated Targeting Using Nonrigid Image Registration Matches Accuracy and Exceeds Precision of Best Manual Approaches to Subthalamic Deep Brain Stimulation Targeting in Parkinson Disease

Neurosurgery ◽  
2015 ◽  
Vol 76 (6) ◽  
pp. 756-765 ◽  
Author(s):  
Srivatsan Pallavaram ◽  
Pierre-François D'Haese ◽  
Wendell Lake ◽  
Peter E. Konrad ◽  
Benoit M. Dawant ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Image Registration ◽  
Parkinson Disease ◽  
Brain Stimulation ◽  
Red Nucleus ◽  
Nonrigid Image Registration ◽  
Direct Targeting ◽  
Fully Automatic ◽  
Stn Dbs ◽  
Deep Brain

Abstract BACKGROUND: Finding the optimal location for the implantation of the electrode in deep brain stimulation (DBS) surgery is crucial for maximizing the therapeutic benefit to the patient. Such targeting is challenging for several reasons, including anatomic variability between patients as well as the lack of consensus about the location of the optimal target. OBJECTIVE: To compare the performance of popular manual targeting methods against a fully automatic nonrigid image registration-based approach. METHODS: In 71 Parkinson disease subthalamic nucleus (STN)-DBS implantations, an experienced functional neurosurgeon selected the target manually using 3 different approaches: indirect targeting using standard stereotactic coordinates, direct targeting based on the patient magnetic resonance imaging, and indirect targeting relative to the red nucleus. Targets were also automatically predicted by using a leave-one-out approach to populate the CranialVault atlas with the use of nonrigid image registration. The different targeting methods were compared against the location of the final active contact, determined through iterative clinical programming in each individual patient. RESULTS: Targeting by using standard stereotactic coordinates corresponding to the center of the motor territory of the STN had the largest targeting error (3.69 mm), followed by direct targeting (3.44 mm), average stereotactic coordinates of active contacts from this study (3.02 mm), red nucleus-based targeting (2.75 mm), and nonrigid image registration-based automatic predictions using the CranialVault atlas (2.70 mm). The CranialVault atlas method had statistically smaller variance than all manual approaches. CONCLUSION: Fully automatic targeting based on nonrigid image registration with the use of the CranialVault atlas is as accurate and more precise than popular manual methods for STN-DBS.

Sign in / Sign up

Export Citation Format

Share Document