Thompson John A, Yin Dali, Ojemann Steven G, Abosch Aviva
Department of Neurosurgery, University of Colorado Denver, Aurora, CO, USA.
Stereotact Funct Neurosurg. 2017;95(4):229-235. doi: 10.1159/000478105. Epub 2017 Jul 21.
The success of deep brain stimulation (DBS) of the internal segment of the globus pallidus (GPi) depends on accurately placing the electrode into the GPi motor territory. Direct targeting can be difficult as GPi laminar borders are not always clearly identifiable on MRI. Here, we report a method for using the putamen (PUT) as a surrogate anatomical marker to target the GPi.
We developed a PUT-based GPi targeting using the FGATIR (fast gray matter acquisition T1-weighted inversion recovery) MRI sequence and compared it with consensus coordinate-based indirect targeting. Stereotactic target coordinates were obtained and analyzed.
In our GPi DBS case sequences, GPi borders were unresolvable on T2-weighted MRI. However, in all cases, application of the PUT-based method resulted in consistently localized GPi targets, which were confirmed by merging the T2-weighted MRI with the FGATIR MRI. Significant differences were noted in the target coordinates between the PUT-based method and indirect targeting based on both the distance from the anterior commissure and the distance from the intercommissural plane. The mean differences for mediolateral distance and anteroposterior distance were 1.4 and 1.42 mm, respectively. In addition, the PUT-based method estimated a target that was closer to the nearest implanted electrode.
Our PUT-based method allows consistent and precise patient-specific GPi targeting. Further study is planned to correlate PUT-based GPi targeting with microelectrode recording, location of active contact of the DBS electrode and clinical outcome.
苍白球内侧部（GPi）深部脑刺激（DBS）的成功取决于将电极准确放置到GPi运动区域。由于在磁共振成像（MRI）上GPi的层状边界并不总是清晰可辨，直接靶向定位可能会很困难。在此，我们报告一种使用壳核（PUT）作为替代解剖标志物来靶向GPi的方法。
我们利用快速灰质采集T1加权反转恢复（FGATIR）MRI序列开发了一种基于PUT的GPi靶向方法，并将其与基于共识坐标的间接靶向方法进行比较。获得并分析立体定向靶点坐标。
在我们的GPi DBS病例序列中，T2加权MRI上无法分辨GPi边界。然而，在所有病例中，应用基于PUT的方法均能一致地定位GPi靶点，通过将T2加权MRI与FGATIR MRI融合得以证实。基于PUT的方法与基于前连合距离和连合间平面距离的间接靶向方法在靶点坐标上存在显著差异。内外侧距离和前后距离的平均差异分别为1.4和1.42毫米。此外，基于PUT的方法估计的靶点更靠近最近植入的电极。
我们基于PUT的方法能够实现针对患者的一致且精确的GPi靶向定位。计划进一步开展研究，将基于PUT的GPi靶向定位与微电极记录、DBS电极有效触点位置及临床结果相关联。
