TY - JOUR
T1 - Targeting of the Subthalamic Nucleus in Patients with Parkinson’s Disease Undergoing Deep Brain Stimulation Surgery
AU - van den Munckhof, Pepijn
AU - Bot, Maarten
AU - Schuurman, P. Richard
N1 - Funding Information: No funding or sponsorship was received for this study or publication of this article. All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published. The DBS team of the AMC received unrestricted research grants from Medtronic and received financial compensation for teaching courses for the European Continue Medical Training program. Pepijn van den Munckhof and Maarten Bot received travel grants from Medtronic. P. Richard Schuurman acts as an independent advisor for Boston Scientific, Elekta and Medtronic. This article is based on previously conducted studies and does not contain any new studies with human participants or animals performed by any of the authors. Publisher Copyright: © 2021, The Author(s). Copyright: Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/6
Y1 - 2021/6
N2 - Precise stereotactic targeting of the dorsolateral motor part of the subthalamic nucleus (STN) is paramount for maximizing clinical effectiveness and preventing side effects of deep brain stimulation (DBS) in patients with advanced Parkinson’s disease. With recent developments in magnetic resonance imaging (MRI) techniques, direct targeting of the dorsolateral part of the STN is now feasible, together with visualization of the motor fibers in the nearby internal capsule. However, clinically relevant discrepancies were reported when comparing STN borders on MRI to electrophysiological STN borders during microelectrode recordings (MER). Also, one should take into account the possibility of a 3D inaccuracy of up to 2 mm of the applied stereotactic technique. Pneumocephalus and image fusion errors may further increase implantation inaccuracy. Even when implantation has been successful, suboptimal lead anchoring on the skull may cause lead migration during follow-up. Meticulous pre- and intraoperative imaging is therefore indispensable, and so is postoperative imaging when the effects of DBS deteriorate during follow-up. Thus far, most DBS centers employ MRI targeting, multichannel MER, and awake test stimulation in STN surgery, but randomized trials comparing surgery under local versus general anesthesia and additional studies comparing MER-STN borders to high-field MRI-STN may change this clinical practice. Further developments in imaging protocols and improvements in image fusion processes are needed to optimize placement of DBS leads in the dorsolateral motor part of the STN in Parkinson’s disease.
AB - Precise stereotactic targeting of the dorsolateral motor part of the subthalamic nucleus (STN) is paramount for maximizing clinical effectiveness and preventing side effects of deep brain stimulation (DBS) in patients with advanced Parkinson’s disease. With recent developments in magnetic resonance imaging (MRI) techniques, direct targeting of the dorsolateral part of the STN is now feasible, together with visualization of the motor fibers in the nearby internal capsule. However, clinically relevant discrepancies were reported when comparing STN borders on MRI to electrophysiological STN borders during microelectrode recordings (MER). Also, one should take into account the possibility of a 3D inaccuracy of up to 2 mm of the applied stereotactic technique. Pneumocephalus and image fusion errors may further increase implantation inaccuracy. Even when implantation has been successful, suboptimal lead anchoring on the skull may cause lead migration during follow-up. Meticulous pre- and intraoperative imaging is therefore indispensable, and so is postoperative imaging when the effects of DBS deteriorate during follow-up. Thus far, most DBS centers employ MRI targeting, multichannel MER, and awake test stimulation in STN surgery, but randomized trials comparing surgery under local versus general anesthesia and additional studies comparing MER-STN borders to high-field MRI-STN may change this clinical practice. Further developments in imaging protocols and improvements in image fusion processes are needed to optimize placement of DBS leads in the dorsolateral motor part of the STN in Parkinson’s disease.
KW - Deep brain stimulation
KW - Magnetic resonance imaging
KW - Microelectrode recordings
KW - Parkinson’s disease
KW - Subthalamic nucleus
KW - Targeting
UR - http://www.scopus.com/inward/record.url?scp=85101445496&partnerID=8YFLogxK
U2 - https://doi.org/10.1007/s40120-021-00233-8
DO - https://doi.org/10.1007/s40120-021-00233-8
M3 - Review article
C2 - 33565018
SN - 2193-8253
VL - 10
SP - 61
EP - 73
JO - Neurology and Therapy
JF - Neurology and Therapy
IS - 1
ER -