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Targeting Neuronal Fiber Tracts for Deep Brain Stimulation Therapy Using Interactive, Patient-Specific Models
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Electrophysiologic Validation of Diffusion Tensor Imaging Tractography during Deep Brain Stimulation Surgery
V A Coenen1, C Jenkner2, C R Honey3
1From the Department of Stereotactic and Functional Neurosurgery (V.A.C., B.M.) volker.coenen@uniklinik-freiburg.de.
AJNR. American Journal of Neuroradiology
|April 2, 2016
Summary
Diffusion tensor imaging fiber tractography shows good concordance with electrophysiology for deep brain stimulation planning. This emerging technology is advisable for surgical assistance when its limitations are understood.
Area of Science:
- Neurosurgery
- Medical Imaging
- Electrophysiology
Background:
- Deep brain stimulation (DBS) is a crucial treatment for neurological disorders.
- Diffusion tensor imaging (DTI) fiber tractography is an emerging technology for DBS planning.
- Electrophysiology is used to assess DBS lead placement accuracy.
Purpose of the Study:
- To investigate the accuracy of DTI fiber tractography-assisted DBS planning.
- To compare DTI fiber tractography with electrophysiology in determining corticospinal tract distance.
- To evaluate the concordance between DTI fiber tractography and intraoperative/postoperative electrophysiology.
Main Methods:
- Eleven patients undergoing subthalamic nucleus DBS were studied.
- DTI and high-resolution MRI scans were performed at 3T.
- Electrode positions and stimulation parameters were analyzed to determine corticospinal tract distance via electrophysiology and DTI fiber tractography.
Main Results:
- Intraoperative electrophysiology showed a mean corticospinal tract distance of 3.0 ± 0.6 mm, compared to 3.0 ± 1.3 mm for DTI.
- Postoperative electrophysiology yielded a mean distance of 3.7 ± 0.7 mm, versus 3.2 ± 1.9 mm for DTI.
- The 95% limits of agreement were ±2.4 mm intraoperatively and ±2.5 mm postoperatively.
Conclusions:
- DTI fiber tractography demonstrated concordance with electrophysiology in depicting the corticospinal tract border.
- While variance was noted, DTI fiber tractography is advisable for DBS procedures if limitations are respected.
- Results align with previous electric field simulation studies.
