Comparison of direct MRI guided versus atlas-based targeting for subthalamic nucleus and globus pallidus deep brain stimulation.

PURPOSE

The subthalamic nucleus (STN) and globus pallidus internus (GPi) targets for deep brain stimulation (DBS) can be defined by atlas coordinates or direct visualisation of the target on MRI. The aim of this study was to evaluate geometric differences between atlas-based targeting and MRI-guided direct targeting.

METHODS

One-hundred-nine Parkinson's disease or dystonia patients records who underwent DBS surgery between 2005 and 2016 were prospectively reviewed. MRI-guided direct targeting coordinates was used to implant 205 STN and 64 GPi electrodes and compared with atlas-based coordinates.

RESULTS

The directly targeted coordinates (mean, SD, range) for STN were : [9.9 ± 1.1 (7.1 - 13.2)], : [-0.8 ± 1.1 (-4.2 - 2)] and : [-4.7 ± 0.53 (-5.9 - -3.2)]. The mean value for the STN was 2.1 mm more medial ( < 0.0001), 1.2 mm more anterior ( < 0.0001) and 0.7 mm more ventral ( < 0.0001) than the atlas target. The targeted coordinates for GPi were : [22.3 ± 2.0 (17.8 - 26.1)], : [-0.2 ± 2.2 (-4.5 - 3.4)], : [-4.3 ± 0.8 (-6.2 - -2.3)]. The mean value for the GPi was 2.2 mm ( < 0.001) more posterior and 0.3 mm ( < 0.01) more ventral than the atlas-based coordinates.

CONCLUSION

MRI-guided targeting may be more accurate than atlas-based targeting due to individual variations in anatomy.