Magnetic resonance imaging techniques for visualization of the subthalamic nucleus

Area of Science:

• Neurosurgery
• Neurology
• Radiology

Background:

• Deep brain stimulation (DBS) is a key treatment for Parkinson disease, requiring precise targeting of the subthalamic nucleus (STN).
• Current MR imaging-based targeting techniques for STN identification lack consensus and present challenges in surgical planning.

Purpose of the Study:

• To review and analyze existing MR imaging-based targeting techniques for STN identification in Parkinson disease patients undergoing DBS.
• To evaluate the strengths and limitations of current indirect and direct MR imaging targeting methods.

Main Methods:

• Systematic review of 70 publications on MR imaging-based STN targeting for DBS.
• Analysis of 33 publications with quantitatively validated results.
• Comparison of indirect targeting (landmarks, atlases) and direct visualization (T2-weighted imaging) techniques.

Main Results:

• No consensus exists on the optimal MR imaging targeting technique for STN DBS surgery.
• Indirect methods lack patient specificity, leading to variable outcomes.
• Direct MR imaging visualization suffers from poor STN contrast and delineation, necessitating intraoperative adjustments.

Conclusions:

• Current MR imaging targeting methods for STN DBS in Parkinson disease are suboptimal.
• Future advancements in MR imaging, such as diffusion imaging, may improve direct STN targeting and functional localization.