Surgical Therapies Improving Movement Program, University of Michigan, Ann Arbor, Michigan.
Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan.
Oper Neurosurg (Hagerstown). 2018 Jun 1;14(6):661-667. doi: 10.1093/ons/opx169.
Accurate electrode placement is critical to the success of deep brain stimulation (DBS) surgery. Suboptimal targeting may arise from poor initial target localization, frame-based targeting error, or intraoperative brain shift. These uncertainties can make DBS surgery challenging.
To develop a computerized system to guide subthalamic nucleus (STN) DBS electrode localization and to estimate the trajectory of intraoperative microelectrode recording (MER) on magnetic resonance (MR) images algorithmically during DBS surgery.
Our method is based upon the relationship between the high-frequency band (HFB; 500-2000 Hz) signal from MER and voxel intensity on MR images. The HFB profile along an MER trajectory recorded during surgery is compared to voxel intensity profiles along many potential trajectories in the region of the surgically planned trajectory. From these comparisons of HFB recordings and potential trajectories, an estimate of the MER trajectory is calculated. This calculated trajectory is then compared to actual trajectory, as estimated by postoperative high-resolution computed tomography.
We compared 20 planned, calculated, and actual trajectories in 13 patients who underwent STN DBS surgery. Targeting errors for our calculated trajectories (2.33 mm ± 0.2 mm) were significantly less than errors for surgically planned trajectories (2.83 mm ± 0.2 mm; P = .01), improving targeting prediction in 70% of individual cases (14/20). Moreover, in 4 of 4 initial MER trajectories that missed the STN, our method correctly indicated the required direction of targeting adjustment for the DBS lead to intersect the STN.
A computer-based algorithm simultaneously utilizing MER and MR information potentially eases electrode localization during STN DBS surgery.
准确的电极放置对于深部脑刺激 (DBS) 手术的成功至关重要。不理想的靶点可能源于初始目标定位不佳、基于框架的靶向误差或术中脑移位。这些不确定性使得 DBS 手术具有挑战性。
开发一种计算机化系统来引导丘脑底核 (STN) DBS 电极定位，并在 DBS 手术期间通过算法估计术中微电极记录 (MER) 在磁共振 (MR) 图像上的轨迹。
我们的方法基于 MER 的高频带 (HFB；500-2000 Hz) 信号与 MR 图像上的体素强度之间的关系。术中记录的 MER 轨迹上的 HFB 轮廓与手术计划轨迹区域内许多潜在轨迹上的体素强度轮廓进行比较。从这些 HFB 记录和潜在轨迹的比较中，计算出 MER 轨迹的估计值。然后将计算出的轨迹与术后高分辨率计算机断层扫描估计的实际轨迹进行比较。
我们比较了 13 名接受 STN DBS 手术的患者的 20 条计划、计算和实际轨迹。我们计算出的轨迹的目标误差（2.33 毫米±0.2 毫米）明显小于手术计划轨迹的误差（2.83 毫米±0.2 毫米；P=0.01），在 70%的个体病例中提高了目标预测（14/20）。此外，在 4 条最初错过 STN 的 MER 轨迹中，我们的方法正确指示了 DBS 导联需要调整的靶向方向，以与 STN 相交。
一种基于计算机的算法同时利用 MER 和 MR 信息，可能会在 STN DBS 手术中简化电极定位。
