Assessment of a method to determine deep brain stimulation targets using deterministic tractography in a navigation...

Area of Science:

• Neurosurgery
• Neurology
• Medical Imaging

Background:

• Current imaging techniques for deep brain stimulation (DBS) in movement disorders can identify target structures but not their internal subdivisions.
• This limitation hinders precise targeting within specific nuclei, potentially affecting stimulation efficacy.
• Accurate targeting is crucial for optimizing therapeutic outcomes in DBS surgery.

Purpose of the Study:

• To develop a straightforward method for identifying an optimized target (OT) within DBS target nuclei.
• To utilize a widely available navigation system for precise DBS targeting.
• To improve the accuracy of electrode placement within subcortical structures for movement disorders.

Main Methods:

• Utilized T1-weighted, T2-weighted, FLAIR, and diffusion tensor imaging (DTI) from nine DBS patients.
• Employed StealthViz® software to segment subcortical targets and their connected projection areas.
• Generated fiber tracts from projection areas and identified intersections with subcortical targets to define the OT.

Main Results:

• Successfully identified optimized targets within the motor part of the subthalamic nucleus and the ventral intermediate nucleus.
• Clinically validated results showed clinically effective electrode contacts (CEEC) were significantly closer to the novel OT compared to atlas-based targets.
• The novel method demonstrated improved precision in targeting internal subdivisions of DBS nuclei.

Conclusions:

• This novel method enables precise optimization of stimulation sites within the internal subdivisions of target nuclei for DBS.
• The technique offers a practical approach to enhance targeting accuracy in DBS surgery for movement disorders.
• Further clinical application of this method could lead to improved patient outcomes in DBS therapy.