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Electrophysiological validation of STN-SNr boundary depicted by susceptibility-weighted MRI

  • Clinical Article - Functional
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Abstract

Background

Direct targeting of subthalamic nucleus (STN) without secondary electrophysiological verification during deep brain stimulation (DBS) is replacing atlas-based indirect targeting techniques. Recent groups have reported increased contrast and better delineation of STN and substantia nigra (SNr) in susceptibility-weighted imaging protocols (SWI). We aim to validate the STN-SNr boundary seen in MRI- SWI by correlating with intraoperative microelectrode recordings (MER) as a part of developing a multi-contrast DBS MRI planning protocol.

Methods

Prospective service evaluation involving electrophysiological verification by correlation of MER trajectory and STN-SNr boundary seen in SWI in seven consecutive patients undergoing DBS surgery were analyzed. The angle of inclination of the STN-SNr boundary and DBS trajectory in the coronal plane were calculated. Considering 4-mm dispersion of a coronal 3 MER array, we predicted, measured, and correlated the depths at which each electrode engaged the boundary.

Results

All central microelectrodes identified the STN-SNr boundary within 1 mm of the predicted depth with 100 % accuracy. Ninety percent of the lateral MER identified the STN-SNr boundary as predicted from SWI and angle of the encounter of the MER front.

Conclusions

The study demonstrates that STN morphology can be depicted using SWI MRI and coincides reliably with the electrophysiological MER boundary. Thus, this imaging modality can be used to refine STN direct targeting protocols in DBS surgery for PD.

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Authors and Affiliations

  1. University of Nottingham Medical School, Nottingham, UK

    J. McEvoy

  2. Department of Neurosurgery, Nottingham University Hospitals, Nottingham, UK

    Ismail Ughratdar & S. Basu

  3. Department of Academic Radiology, University of Nottingham Medical School, Nottingham, UK

    S. Schwarz & S. Basu

  4. University Hospitals Birmingham NHS Trust, Mindelsohn Way Edgbaston, Birmingham, B15 2TH, UK

    Ismail Ughratdar

Authors
  1. J. McEvoy
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  2. Ismail Ughratdar
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  3. S. Schwarz
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  4. S. Basu
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Corresponding author

Correspondence to Ismail Ughratdar.

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Ethics Approval

This study was approved by Nottingham University Hospitals ethics committee and has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. All persons gave their informed consent prior to their inclusion in the study.

Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

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McEvoy, J., Ughratdar, I., Schwarz, S. et al. Electrophysiological validation of STN-SNr boundary depicted by susceptibility-weighted MRI. Acta Neurochir 157, 2129–2134 (2015). https://doi.org/10.1007/s00701-015-2615-1

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  • DOI: https://doi.org/10.1007/s00701-015-2615-1

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