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Neuroimaging Technological Advancements for Targeting in Functional Neurosurgery

  • Neuroimaging (N Pavese, Section Editor)
  • Published:
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Abstract

Purpose of Review

Ablations and particularly deep brain stimulation (DBS) of a variety of CNS targets are established therapeutic tools for movement disorders. Accurate targeting of the intended structure is crucial for optimal clinical outcomes. However, most targets used in functional neurosurgery are sub-optimally visualized on routine MRI. This article reviews recent neuroimaging advancements for targeting in movement disorders.

Recent Findings

Dedicated MRI sequences can often visualize to some degree anatomical structures commonly targeted during DBS surgery, including at 1.5-T field strengths. Due to recent technological advancements, MR images using ultra-high magnetic field strengths and new acquisition parameters allow for markedly improved visualization of common movement disorder targets. In addition, novel neuroimaging techniques have enabled group-level analysis of DBS patients and delineation of areas associated with clinical benefits. These areas might diverge from the conventionally targeted nuclei and may instead correspond to white matter tracts or hubs of functional networks.

Summary

Neuroimaging advancements have enabled improved direct visualization-based targeting as well as optimization and adjustment of conventionally targeted structures.

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Authors and Affiliations

  1. Joint Department of Medical Imaging, University of Toronto, Toronto, ON, Canada

    Alexandre Boutet & Walter Kucharczyk

  2. University Health Network, Toronto, ON, Canada

    Alexandre Boutet, Robert Gramer, Gavin J. B. Elias, Jürgen Germann, Ricardo Maciel, Walter Kucharczyk & Andres M. Lozano

  3. Department of Psychology, Concordia University, Montreal, Quebec, Canada

    Christopher J. Steele

  4. Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany

    Christopher J. Steele

  5. Division of Neurology, Edmond J. Safra Program in Parkinson’s Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN University of Toronto, Toronto, Ontario, Canada

    Ricardo Maciel

  6. Functional Neurosurgery Unit, Department of Clinical and Movement Neurosciences, University College London, Queen Square Institute of Neurology, London, UK

    Ludvic Zrinzo

  7. University Health Network, Toronto, ON, UK

    Alfonso Fasano

  8. Krembil Brain Institute, Movement Disorders Centre - Toronto Western Hospital, 399 Bathurst St, 7McL410, Toronto, ON, M5T 2S8, Canada

    Alfonso Fasano

  9. Center for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, ON, Canada

    Alfonso Fasano

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  1. Alexandre Boutet
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Correspondence to Alfonso Fasano.

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Conflict of Interest

Alexandre Boutet, Robert Gramer, Christopher J. Steele, Gavin J. B. Elias, Jürgen Germann, Ricardo Maciel, Walter Kucharczyk each declare no potential conflicts of interest. Ludvic Zrinzo reports honoraria for presenting educational material at meetings from Medtronic and Boston Scientific, outside the submitted work. Andres M. Lozano reports personal fees from Medtronic, St Jude, and Boston Scientific and Functional Neuromodulation, during the conduct of the study, and grants from GE Healthcare, outside the submitted work. Alfonso Fasano reports grants, personal fees, and non-financial support from Abbvie; grants, personal fees, and non-financial support from Medtronic; grants and personal fees from Boston Scientific; personal fees from Sunovion; personal fees from Chiesi farmaceutici; personal fees from UCB; and grants and personal fees from Ipsen, outside the submitted work.

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Boutet, A., Gramer, R., Steele, C.J. et al. Neuroimaging Technological Advancements for Targeting in Functional Neurosurgery. Curr Neurol Neurosci Rep 19, 42 (2019). https://doi.org/10.1007/s11910-019-0961-8

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