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An Assessment of Current Brain Targets for Deep Brain Stimulation Surgery With Susceptibility-Weighted Imaging at 7 Tesla

Abosch, Aviva MD, PhD; Yacoub, Essa PhD; Ugurbil, Kamil PhD; Harel, Noam PhD

Neurosurgery:
doi: 10.1227/NEU.0b013e3181f74105
Concepts, Innovations, and Techniques
Abstract

BACKGROUND: Deep brain stimulation (DBS) surgery is used for treating movement disorders, including Parkinson disease, essential tremor, and dystonia. Successful DBS surgery is critically dependent on precise placement of DBS electrodes into target structures. Frequently, DBS surgery relies on normalized atlas-derived diagrams that are superimposed on patient brain magnetic resonance imaging (MRI) scans, followed by microelectrode recording and macrostimulation to refine the ultimate electrode position. Microelectrode recording carries a risk of hemorrhage and requires active patient participation during surgery.

OBJECTIVE: To enhance anatomic imaging for DBS surgery using high-field MRI with the ultimate goal of improving the accuracy of anatomic target selection.

METHODS: Using a 7-T MRI scanner combined with an array of acquisition schemes using multiple image contrasts, we obtained high-resolution images of human deep nuclei in healthy subjects.

RESULTS: Superior image resolution and contrast obtained at 7 T in vivo using susceptibility-weighted imaging dramatically improved anatomic delineation of DBS targets and allowed the identification of internal architecture within these targets. A patient-specific, 3-dimensional model of each target area was generated on the basis of the acquired images.

CONCLUSION: Technical developments in MRI at 7 T have yielded improved anatomic resolution of deep brain structures, thereby holding the promise of improving anatomic-based targeting for DBS surgery. Future study is needed to validate this technique in improving the accuracy of targeting in DBS surgery.

Author Information

1Department of Neurosurgery, University of Minnesota Medical School, Minneapolis, Minnesota

2Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota Medical School, Minneapolis, Minnesota

3Center for Magnetic Resonance Research, Departments of Radiology and Neurosurgery, University of Minnesota Medical School, Minneapolis, Minnesota

Received, June 15, 2009.

Accepted, April 19, 2010.

*These authors have contributed equally to this article.

Reprint requests: Aviva Abosch, MD, PhD, Director of Epilepsy, Stereotactic, and Functional Neurosurgery, Department of Neurosurgery, University of Minnesota Medical School, D429 Mayo Memorial Bldg, 420 Delaware St, SE MMC 96, Minneapolis, MN 55455. E-mail: aabosch@umn.edu

Copyright © by the Congress of Neurological Surgeons