Sweet Jennifer A, Pace Jonathan, Girgis Fady, Miller Jonathan P
Department of Neurosurgery, University Hospitals Case Medical Center, Case Western Reserve University Cleveland, OH, USA.
Front Neuroanat. 2016 Jun 30;10:71. doi: 10.3389/fnana.2016.00071. eCollection 2016.
Accurate surgical localization of the varied targets for deep brain stimulation (DBS) is a process undergoing constant evolution, with increasingly sophisticated techniques to allow for highly precise targeting. However, despite the fastidious placement of electrodes into specific structures within the brain, there is increasing evidence to suggest that the clinical effects of DBS are likely due to the activation of widespread neuronal networks directly and indirectly influenced by the stimulation of a given target. Selective activation of these complex and inter-connected pathways may further improve the outcomes of currently treated diseases by targeting specific fiber tracts responsible for a particular symptom in a patient-specific manner. Moreover, the delivery of such focused stimulation may aid in the discovery of new targets for electrical stimulation to treat additional neurological, psychiatric, and even cognitive disorders. As such, advancements in surgical targeting, computational modeling, engineering designs, and neuroimaging techniques play a critical role in this process. This article reviews the progress of these applications, discussing the importance of target localization for DBS, and the role of computational modeling and novel neuroimaging in improving our understanding of the pathophysiology of diseases, and thus paving the way for improved selective target localization using DBS.
准确地对深部脑刺激（DBS）的各种靶点进行手术定位是一个不断发展的过程，技术越来越复杂，以实现高度精确的靶向。然而，尽管电极被精心放置在脑内的特定结构中，但越来越多的证据表明，DBS的临床效果可能是由于对给定靶点的刺激直接和间接影响的广泛神经元网络的激活。以患者特异性方式靶向负责特定症状的特定纤维束，选择性激活这些复杂且相互连接的通路可能会进一步改善当前所治疗疾病的疗效。此外，这种聚焦刺激的传递可能有助于发现用于电刺激治疗其他神经、精神甚至认知障碍的新靶点。因此，手术靶向、计算建模、工程设计和神经成像技术的进步在这一过程中起着关键作用。本文回顾了这些应用的进展，讨论了DBS靶点定位的重要性，以及计算建模和新型神经成像在增进我们对疾病病理生理学理解方面的作用，从而为使用DBS改善选择性靶点定位铺平道路。
