Bolier Erik, Holewijn Rozemarije, De Bie Rob M A, Beudel Martijn, van den Munckhof Pepijn, Schuurman Richard, Bot Maarten
Neurosurgery, Amsterdam University Medical Centres, Amsterdam, Netherlands
Neurosurgery, Amsterdam University Medical Centres, Amsterdam, Netherlands.
J Neurol Neurosurg Psychiatry. 2024 Jul 20;96(3). doi: 10.1136/jnnp-2023-333164.
Visualisation of the dorsolateral subthalamic nucleus (STN) remains challenging on 1.5 and 3Tesla T2-weighted MRI. Our previously defined hotspot, relative to the well-visualised medial STN border, serves as an MRI landmark for dorsolateral STN identification in deep brain stimulation (DBS). We aimed to validate this hotspot in a separate trial cohort of Parkinson's disease (PD) patients and refine its location.
In this post hoc analysis of a randomised controlled trial, in which the hotspot was taken into account during target planning, responses to DBS were evaluated using hemibody improvement on the Movement Disorder Society-Unified Parkinson's Disease Rating Scale motor examination and compared with our historical cohort, as well as dopaminergic medication reduction. Then, a refined hotspot was calculated and the Euclidean distance from individual active contacts to the refined hotspot was correlated with motor improvement.
The first quartile of the hemibodies (poor responders) showed an average improvement of 13%, which was higher than the -8% in the historical control group (p=0.044). Dopaminergic medication reduction was greater in the current cohort compared with the historical cohort (p=0.020). Overall variability of hemibody motor improvement was reduced in the current cohort compared with the historical control group (p=0.003). Motor improvement correlated to the Euclidean distance from active contact to the refined hotspot (2.8 mm lateral, 1.1 mm anterior and 2.2 mm superior to the medial STN border) (p=0.001).
We validated the hotspot for dorsolateral STN targeting in DBS for patients with PD and showed an improved motor response in poor responders, a reduced variability in motor improvement and a greater dopaminergic medication reduction. We then refined the hotspot at 2.8 mm lateral, 1.1 mm anterior and 2.2 mm superior relative to the medial STN border, which visualises a readily implementable target within the dorsolateral STN on lower field strength MRI.
在1.5特斯拉和3特斯拉的T2加权磁共振成像（MRI）上，丘脑底核背外侧部（STN）的可视化仍然具有挑战性。相对于可视化良好的内侧STN边界，我们之前定义的热点可作为深部脑刺激（DBS）中背外侧STN识别的MRI标志。我们旨在在另一组帕金森病（PD）患者试验队列中验证这一热点，并优化其位置。
在这项随机对照试验的事后分析中，目标规划时考虑了热点，使用运动障碍协会统一帕金森病评定量表运动检查中的半身改善情况评估DBS反应，并与我们的历史队列以及多巴胺能药物减少情况进行比较。然后，计算出优化后的热点，并将各个有效触点到优化后热点的欧几里得距离与运动改善情况进行关联。
半身情况的第一个四分位数（反应较差者）显示平均改善了13%，高于历史对照组的-8%（p=0.044）。与历史队列相比，当前队列中多巴胺能药物的减少幅度更大（p=0.020）。与历史对照组相比，当前队列中半身运动改善的总体变异性降低（p=0.003）。运动改善与有效触点到优化后热点的欧几里得距离相关（位于内侧STN边界外侧2.8毫米、前方1.1毫米和上方2.2毫米处）（p=0.001）。
我们验证了PD患者DBS中背外侧STN靶向的热点，并显示反应较差者的运动反应得到改善，运动改善的变异性降低，多巴胺能药物减少幅度更大。然后，我们将热点优化到相对于内侧STN边界外侧2.8毫米、前方1.1毫米和上方2.2毫米处，这在低场强MRI上可显示出背外侧STN内一个易于实施的靶点。
