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CC BY-NC-ND 4.0 · Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 2020; 39(04): 271-278
DOI: 10.1055/s-0037-1603579
Review Article | Artigo de Revisão

Landmarks for the Location of the Subthalamic Nucleus Using Magnetic Resonance Imaging

Marcos para a localização do núcleo subtalâmico por ressonância magnética
Luiza Louza Normanha
1   Department of Medicine, Pontifícia Universidade Católica de Goiás (PUC Goiás), Goiânia, GO, Brazil
,
Jéssica Rodrigues Borges Leão
1   Department of Medicine, Pontifícia Universidade Católica de Goiás (PUC Goiás), Goiânia, GO, Brazil
,
Ledismar José Silva 
2   Department of Neurosurgery, Pontifícia Universidade Católica de Goiás (PUC Goiás), Goiânia, GO, Brazil
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Abstract

Deep brain stimulation has become an option for advanced Parkinson's disease treatment since the 1990s, but the first reports are from Benabid's team, a French neurosurgeon, in the 1980s. The subthalamic nucleus (STN), more specifically its dorsolateral portion, is the most commonly stimulated brain area. One of the major aspects for a good surgical result is the accurate location of this target. Therefore, the present article aimed to identify landmarks that facilitate and refine the location of the STN using nuclear magnetic resonance imaging (NMRI) of the skull. In order to achieve this goal, a search for articles was performed using the PubMed and Science Direct online databases, and articles regarding the use of NMRI to target STN were included. The precise location of the dorsolateral portion of the STN is fundamental to achieve the best possible effect on motor symptoms and to minimize side effects. One of the most used location methods is the NMRI, associated or not with tomography or ventriculography. The location strategies can be classified as direct and indirect. Landmarks are among the indirect strategies, and the most important ones (red nucleus, Sukeroku sign, dent internal capsule sign, supramammillary commissure, mammillothalamic tract, and interpeduncular cistern) are described in the present article. The various landmarks can be combined to locate with more accuracy the dorsolateral portion of the STN and the ideal position of the electrodes to achieve the best possible clinical result.

Resumo

A estimulação cerebral profunda surgiu como opção terapêutica para a doença de Parkinson avançada na década de 1990, mas os primeiros relatos são do grupo de Benabid, neurocirurgião francês, na década de 1980. O núcleo subtalâmico (NST), mais especificamente sua porção dorsolateral, é o alvo mais comumente abordado. Um dos fatores primordiais para o bom resultado cirúrgico é a localização precisa desse alvo. Assim, este artigo teve como objetivo identificar marcos que facilitem e aprimorem a localização do NST por ressonância nuclear magnética (RNM) de crânio. Para isso, foi realizada busca de artigos nas bases de dados PubMed e Science Direct, incluindo-se estudos sobre o uso da RNM de crânio para localização do NST. A localização precisa da porção dorsolateral do NST é de fundamental importância para se atingir a melhor resposta clínica sobre os sintomas motores da doença e minimizar os efeitos colaterais. A RNM de crânio é uma das modalidades de localização mais utilizadas, podendo ser associada ou não à tomografia de crânio ou à ventriculografia. As estratégias de localização podem ser classificadas em direta e indireta. Os marcos estão entre as estratégias indiretas de visualização, e os principais (núcleo rubro, sinal de Sukeroku, sinal do entalhe da cápsula interna, comissura supramamilar, trato mamilo talâmico e cisterna interpeduncular) são descritos neste artigo. Os diversos marcos podem ser utilizados de forma integrada para se obter localização mais precisa da porção dorsolateral do NST e o posicionamento ideal dos eletrodos para atingir melhor resposta clínica.

Keywords

Parkinson disease - deep brain stimulation - subthalamic nucleus - anatomical landmarks

Palavras-chave

doença de Parkinson - estimulação cerebral profunda - núcleo subtalâmico - marcos anatômicos


Publication History

Received: 01 February 2017

Accepted: 02 May 2017

Article published online:
31 May 2017

© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Smith Y, Wichmann T, Factor SA, DeLong MR. Parkinson's disease therapeutics: new developments and challenges since the introduction of levodopa. Neuropsychopharmacology 2012; 37 (01) 213-246
    CrossrefPubMedGoogle Scholar
  • 2 Groiss SJ, Wojtecki L, Südmeyer M, Schnitzler A. Deep brain stimulation in Parkinson's disease. Ther Adv Neurol Disorder 2009; 2 (06) 20-28
    PubMedGoogle Scholar
  • 3 Kern DS, Kumar R. Deep brain stimulation. Neurologist 2007; 13 (05) 237-252
    CrossrefPubMedGoogle Scholar
  • 4 Brunenberg EJL, Platel B, Hofman PAM, Ter Haar Romeny BM, Visser-Vandewalle V. Magnetic resonance imaging techniques for visualization of the subthalamic nucleus. J Neurosurg 2011; 115 (05) 971-984
    CrossrefPubMedGoogle Scholar
  • 5 Bronte-Stewart HB. Surgical placement of deep brain stimulation leads for the treatment of movement disorders: intraoperative aspects. In: Marks Jr WJ. editor. Deep brain stimulation management. Cambridge: Cambridge University Press, Deep brain stimulation management; 2011: 20-31
    Google Scholar
  • 6 Toda H, Sawamoto N, Hanakawa T. et al. A novel composite targeting method using high-field magnetic resonance imaging for subthalamic nucleus deep brain stimulation. J Neurosurg 2009; 111 (04) 737-745
    CrossrefPubMedGoogle Scholar
  • 7 Massey LA, Yousry TA. Anatomy of the substantia nigra and subthalamic nucleus on MR imaging. Neuroimaging Clin N Am 2010; 20 (01) 7-27
    CrossrefPubMedGoogle Scholar
  • 8 Hamani C, Saint-Cyr JA, Fraser J, Kaplitt M, Lozano AM. The subthalamic nucleus in the context of movement disorders. Brain 2004; 127 (Pt 1): 4-20
    CrossrefPubMedGoogle Scholar
  • 9 Chen SY, Tsai ST, Lin SH. Controversial issues in deep brain stimulation in Parkinson's disease. In: Finkelstein D. editor. Towards new therapies for Parkinson's Disease. Rijeka: In Tech Europe; 2011: 1-20 . Access: 2016 (Set 12) at: http://cdn.intechopen.com/pdfs-wm/22876.pdf
    Google Scholar
  • 10 Starr PA. Placement of deep brain stimulators into the subthalamic nucleus or Globus pallidus internus: technical approach. Stereotact Funct Neurosurg 2002; 79 (3-4): 118-145
    CrossrefPubMedGoogle Scholar
  • 11 Deogaonkar M, Freitas T, Machado A, Rezai A. Subthalamic nucleus targeting using interpeduncular cistern as an internal landmark. Neurosurgery 2011; 69 (2, Suppl Operative) ons225-ons229
    CrossrefPubMedGoogle Scholar
  • 12 Andrade-Souza YM, Schwalb JM, Hamani C. et al. Comparison of three methods of targeting the subthalamic nucleus for chronic stimulation in Parkinson's disease. Neurosurgery 2008; 62 (Suppl. 02) 875-883
    PubMedGoogle Scholar
  • 13 Bejjani BP, Dormont D, Pidoux B. et al. Bilateral subthalamic stimulation for Parkinson's disease by using three-dimensional stereotactic magnetic resonance imaging and electrophysiological guidance. J Neurosurg 2000; 92 (04) 615-625
    CrossrefPubMedGoogle Scholar
  • 14 Taoka T, Hirabayashi H, Nakagawa H. et al. “Sukeroku sign” and “dent internal-capsule sign”--identification guide for targeting the subthalamic nucleus for placement of deep brain stimulation electrodes. Neuroradiology 2009; 51 (01) 11-16
    CrossrefPubMedGoogle Scholar
  • 15 Lee C, Young B, Sanders MF. The role of the supramammillary commissure in MR localization of the subthalamic nucleus. Stereotact Funct Neurosurg 2006; 84 (5-6): 193-204
    CrossrefPubMedGoogle Scholar
  • 16 Caire F, Maubon A, Moreau JJ, Cuny E. The mamillothalamic tract is a good landmark for the anterior border of the subthalamic nucleus on axial MR images. Stereotact Funct Neurosurg 2011; 89 (05) 286-290
    CrossrefPubMedGoogle Scholar