Using MDEFT MRI Sequences to Target the GPi in DBS Surgery

Area of Science:

• Neurosurgery
• Radiology
• Medical Imaging

Background:

• Deep Brain Stimulation (DBS) surgery requires precise targeting of brain structures like the Globus pallidus internus (GPi).
• Advanced MRI sequences, such as Modified Driven Equilibrium Fourier Transform (MDEFT), offer high spatial resolution and contrast for improved visualization.
• MDEFT sequences show potential for direct visualization and targeting of the GPi, crucial for DBS procedures.

Purpose of the Study:

• To investigate the accuracy and reliability of MDEFT sequences for direct GPi targeting in DBS surgery.
• To compare direct targeting using MDEFT sequences with traditional atlas-based targeting methods.
• To assess the precision of MDEFT-guided GPi targeting for patients with dystonia and Parkinson's disease (PD).

Main Methods:

• 13 patients undergoing bilateral GPi-DBS for dystonia or PD were included.
• Preoperative GPi targeting was performed visually using MDEFT sequences and compared with atlas-based coordinates.
• Postoperative CT imaging was used to determine the location of implanted leads and active electrodes relative to the segmented GPi.

Main Results:

• The GPi was well-demarcated on MDEFT sequences in most patients.
• Direct MDEFT targeting resulted in mean coordinates significantly more posterior than atlas-based planning.
• Active electrode contacts were located in the inferior and posterior motor region of the GPi for both dystonia and PD patients.

Conclusions:

• MDEFT MRI sequences facilitate precise identification and direct visual targeting of the GPi due to high resolution and contrast.
• Direct MDEFT targeting leads to significantly different target coordinates compared to atlas-based approaches.
• Observed variability in targeting among PD and dystonia patients underscores the need for individualized GPi targeting.