Vedaei Faezeh, Fayed Islam, Alizadeh Mahdi, Miller Christopher, Zhang Ashley B, Koa Victoria, Khan Suharto, Mohamed Feroze B, Wu Chengyuan
Department of Radiology, Jefferson Integrated Magnetic Resonance Imaging Center, Thomas Jefferson University, Philadelphia , Pennsylvania , USA.
Department of Neurological Surgery, Vickie and Jack Farber Institute for Neuroscience, Thomas Jefferson University, Philadelphia , Pennsylvania , USA.
Neurosurgery. 2023 Sep 1;93(3):691-698. doi: 10.1227/neu.0000000000002478. Epub 2023 Apr 3.
Precise electrode position is vital for effective deep brain stimulation in treating motor symptoms in Parkinson's disease (PD). Enlarged perivascular spaces (PVSs) are associated with pathophysiology of neurodegenerative diseases including PD and may affect the microstructure of surrounding brain tissue.
To quantify the clinical implications of enlarged PVS on tractography-based stereotactic targeting in patients with advanced PD selected to undergo deep brain stimulation.
Twenty patients with PD underwent MRI scanning. The PVS areas were visualized and segmented. Based on the size of the PVS areas, the patient group was split into 2 categories of large vs small PVSs. Probabilistic and deterministic tractography methods were applied to a diffusion-weighted data set. Fiber assignment was performed using motor cortex as an initiation seed and the globus pallidus interna and subthalamic nucleus, separately, as inclusion masks. Two exclusion masks used consisted of cerebral peduncles and the PVS mask. The center of gravity of the tract density map was measured and compared between the tracts generated with and without consideration of the PVS mask.
The average differences between the center of gravity of the tracts made by excluding PVS and without excluding PVS using deterministic and probabilistic tractography methods were less than 1 mm. Statistical analysis showed nonsignificant differences between deterministic and probabilistic methods and differences between patients with large and small PVSs ( P > .05).
This study demonstrated that the presence of enlarged PVS is unlikely to affect targeting of basal ganglia nuclei based on tractography.
精确的电极位置对于帕金森病（PD）运动症状的有效深部脑刺激至关重要。血管周围间隙（PVS）扩大与包括PD在内的神经退行性疾病的病理生理学相关，并且可能影响周围脑组织的微观结构。
量化扩大的PVS对选择接受深部脑刺激的晚期PD患者基于纤维束成像的立体定向靶点的临床影响。
20例PD患者接受了MRI扫描。对PVS区域进行可视化和分割。根据PVS区域的大小，将患者组分为大PVS和小PVS两类。将概率性和确定性纤维束成像方法应用于扩散加权数据集。使用运动皮层作为起始种子，并分别以内侧苍白球和丘脑底核作为包含掩码进行纤维分配。使用的两个排除掩码包括大脑脚和PVS掩码。测量并比较在考虑和不考虑PVS掩码的情况下生成的纤维束之间的纤维束密度图重心。
使用确定性和概率性纤维束成像方法，排除PVS和不排除PVS所生成的纤维束重心之间的平均差异小于1毫米。统计分析显示，确定性和概率性方法之间以及大PVS和小PVS患者之间的差异无统计学意义（P>.05）。
本研究表明，扩大的PVS的存在不太可能影响基于纤维束成像的基底神经节核靶点定位。
