The Accuracy of Direct Targeting Using Fusion of MR and CT Imaging for Deep Brain Stimulation of the Subthalamic Nucleus in Patients with Parkinson's Disease

Fadi Almahariq; Goran Sedmak; Vladimira Vuletić; Domagoj Dlaka; Darko Orešković; Petar Marčinković; Marina Raguž; Darko Chudy

doi:10.1055/s-0040-1715826

Journal of Neurological Surgery Part A: Central European Neurosurgery, Inhaltsverzeichnis

J Neurol Surg A Cent Eur Neurosurg 2021; 82(06): 518-525
DOI: 10.1055/s-0040-1715826

Original Article

The Accuracy of Direct Targeting Using Fusion of MR and CT Imaging for Deep Brain Stimulation of the Subthalamic Nucleus in Patients with Parkinson's Disease

Fadi Almahariq

¹Department of Neurosurgery, Clinical Hospital Dubrava, Zagreb, Croatia

²Center of Excellence in Basic, Clinical and Translational Neuroscience, Zagreb, Croatia

,

Goran Sedmak

²Center of Excellence in Basic, Clinical and Translational Neuroscience, Zagreb, Croatia

³Croatian Institute for Brain Research, School of Medicine, University of Zagreb, Zagreb, Croatia

,

Vladimira Vuletić

⁴Department of Neurology, School of Medicine, University of Rijeka, University Hospital Rijeka, Rijeka, Croatia

,

Domagoj Dlaka

¹Department of Neurosurgery, Clinical Hospital Dubrava, Zagreb, Croatia

,

Darko Orešković

¹Department of Neurosurgery, Clinical Hospital Dubrava, Zagreb, Croatia

,

Petar Marčinković

¹Department of Neurosurgery, Clinical Hospital Dubrava, Zagreb, Croatia

,

Marina Raguž

¹Department of Neurosurgery, Clinical Hospital Dubrava, Zagreb, Croatia

,

Darko Chudy

¹Department of Neurosurgery, Clinical Hospital Dubrava, Zagreb, Croatia

²Center of Excellence in Basic, Clinical and Translational Neuroscience, Zagreb, Croatia

⁵Department of Surgery, School of Medicine, University of Zagreb, Zagreb, Croatia

› Institutsangaben

Abstract

Introduction In 33 consecutive patients with Parkinson's disease (PD) undergoing awake deep brain stimulation (DBS) without microelectrode recording (MER), we assessed and validated the precision and accuracy of direct targeting of the subthalamic nucleus (STN) using preoperative magnetic resonance imaging (MRI) and stereotactic computed tomography (CT) image fusion combined with immediate postoperative stereotactic CT and postoperative MRI, and we report on the side effects and clinical results up to 6 months' follow-up.

Materials and Methods Preoperative nonstereotactic MRI and stereotactic CT images were merged and used for planning the trajectory and final lead position. Immediate postoperative stereotactic CT and postoperative nonstereotactic MRI provided the validation of the final electrode position. Changes in the Unified Parkinson's Disease Rating Scale III (UPDRS III) scores and the levodopa equivalent daily doses (LEDD) and appearance of adverse side effects were assessed.

Results The mean Euclidian distance (ED) error between the planned position and the final position of the lead in the left STN was 1.69 ± 0.82 mm and that in the right STN was 2.12 ± 1.00. The individual differences between planned and final position in each of the three coordinates were less than 2 mm. The UPDRS III scores improved by 75% and LEDD decreased by 45%. Few patients experienced complications, such as postoperative infection (n = 1), or unwanted side effects, such as emotional instability (n = 1).

Conclusion Our results confirm that direct targeting of an STN on stereotactic CT merged with MRI could be a valid method for placement the DBS electrode. The magnitude of our targeting error is comparable with the reported errors when using MER and other direct targeting approaches.

Keywords

STN - deep brain stimulation - Parkinson's disease - UPDRS III - stereotactic surgery

Volltext

Referenzen

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