Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
SHR Neuro Krebs Kardio Lipid Stoffw Microb
Holl, EM; Petersen, EA; Foltynie, T; Martinez-Torres, I; Limousin, P; Hariz, MI; Zrinzo, L.
Improving targeting in image-guided frame-based deep brain stimulation.
NEUROSURGERY. 2010; 67(2 Suppl Operative): 437-447.
Doi: 10.1227/NEU.0b013e3181f7422a
Web of Science
PubMed
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- Führende Autor*innen der Med Uni Graz
- Holl Etienne
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- Abstract:
- BACKGROUND: Deep brain stimulation (DBS) is commonly used in the treatment of movement disorders such as Parkinson disease (PD), dystonia, and other tremors. OBJECTIVE: To examine systematic errors in image-guided DBS electrode placement and to explore a calibration strategy for stereotactic targeting. METHODS: Pre- and postoperative stereotactic MR images were analyzed in 165 patients. The perpendicular error between planned target coordinates and electrode trajectory was calculated geometrically for all 312 DBS electrodes implanted. Improvement in motor unified PD rating scale III subscore was calculated for those patients with PD with at least 6 months of follow-up after bilateral subthalamic DBS. RESULTS: Mean (standard deviation) scalar error of all electrodes was 1.4(0.9) mm with a significant difference between left and right hemispheres. Targeting error was significantly higher for electrodes with coronal approach angle (ARC) >= 10 degrees (P < .001). Mean vector error was X: -0.6, Y: -0.7, and Z: -0.4 mm (medial, posterior, and superior directions, respectively). Targeting error was significantly improved by using a systematic calibration strategy based on ARC and target hemisphere (mean: 0.6 mm, P < .001) for 47 electrodes implanted in 24 patients. Retrospective theoretical calibration for all 312 electrodes would have reduced the mean (standard deviation) scalar error from 1.4(0.9) mm to 0.9(0.5) mm (36% improvement). With calibration, 97% of all electrodes would be within 2 mm of the intended target as opposed to 81% before calibration. There was no significant correlation between the degree of error and clinical outcome from bilateral subthalamic nucleus DBS (R-2 = 0.07). CONCLUSION: After calibration of a systematic targeting error an MR image-guided stereotactic approach would be expected to deliver 97% of all electrodes to within 2 mm of the intended target point with a single brain pass.
- Find related publications in this database (using NLM MeSH Indexing)
- Brain - anatomy and histology
- Deep Brain Stimulation - methods
- Electrodes, Implanted - standards
- Female -
- Humans -
- Magnetic Resonance Imaging - methods
- Male -
- Middle Aged -
- Movement Disorders - therapy
- Neuronavigation - methods
- Outcome Assessment (Health Care) - methods
- Postoperative Complications - prevention and control
- Stereotaxic Techniques - standards
- Surgery, Computer-Assisted - methods
- Find related publications in this database (Keywords)
- Calibration
- Deep brain stimulation
- Dystonia
- Magnetic resonance imaging
- Parkinson disease
- Stereotactic accuracy
- Subthalamic nucleus