Simulation and assessment of cerebrovascular damage in deep brain stimulation using a stereotactic atlas of vasculature and structure derived from multiple 3- and 7-tesla scans

Technical note

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Object

The most severe complication of deep brain stimulation (DBS) is intracranial hemorrhage. Detailed knowledge of the cerebrovasculature could reduce the rate of this disorder. Morphological scans typically acquired in stereotactic and functional neurosurgery (SFN) by using 1.5-T (or sometimes even 3-T) imaging units poorly depict the vasculature. Advanced angiographic imaging, including 3- and 7-T 3D time-of-flight and susceptibility weighted imaging as well as 320-slice CT angiography, depict the vessels in great detail. However, these acquisitions are not used in SFN clinical practice, and robust methods for their processing are not available yet. Therefore, the authors proposed the use of a detailed 3D stereotactic cerebrovascular atlas to assist in SFN planning and to potentially reduce DBS-induced hemorrhage.

Methods

A very detailed 3D cerebrovascular atlas of arteries, veins, and dural sinuses was constructed from multiple 3- and 7-T scans. The atlas contained > 900 vessels, each labeled with a name and diameter with the smallest having a 90-μm diameter. The cortical areas, ventricular system, and subcortical structures were fully segmented and labeled, including the main stereotactic target structures: subthalamic nucleus, ventral intermediate nucleus of the thalamus, and internal globus pallidus. The authors also developed a computer simulator with the embedded atlas that was able to compute the effective electrode trajectory by minimizing penetration of the cerebrovascular system and vital brain structures by a DBS electrode. The simulator provides the neurosurgeon with functions for atlas manipulation, target selection, trajectory planning and editing, 3D display and manipulation, and electrode-brain penetration calculation.

Results

This simulation demonstrated that a DBS electrode inserted in the middle frontal gyrus may intersect several arteries and veins including 1) the anteromedial frontal artery of the anterior cerebral artery as well as the prefrontal artery and the precentral sulcus artery of the middle cerebral artery (range of diameters 0.4–0.6 mm); and 2) the prefrontal, anterior caudate, and medullary veins (range of diameters 0.1–2.3 mm). This work also shows that field strength and pulse sequence have a substantial impact on vessel depiction. The numbers of 3D vascular segments are 215, 363, and 907 for 1.5-, 3-, and 7-T scans, respectively.

Conclusions

Inserting devices into the brain during microrecording and stimulation may cause microbleeds not discernible on standard scans. A small change in the location of the DBS electrode can result in a major change for the patient. The described simulation increases the neurosurgeon's awareness of this phenomenon. The simulator enables the neurosurgeon to analyze the spatial relationships between the track and the cerebrovasculature, ventricles, subcortical structures, and cortical areas, which allows the DBS electrode to be placed more effectively, and thus potentially reducing the invasiveness of the stimulation procedure for the patient.

Abbreviations used in this paper: DBS = deep brain stimulation; GPi = internal globus pallidus; MER = microelectrode recording; PFA = probabilistic functional atlas; SFN = stereotactic and functional neurosurgery; SPGR = spoiled gradient recalled acquisition in steady state; STN = subthalamic nucleus; TOF = time-of-flight; VIM = ventral intermediate nucleus of the thalamus.

Article Information

Address correspondence to: Wieslaw L. Nowinski, D.Sc., Ph.D., Biomedical Imaging Lab, Agency for Science, Technology and Research, 30 Biopolis Street, #07-01 Matrix, Singapore 138671. email: wieslaw@sbic.a-star.edu.sg.

Please include this information when citing this paper: published online March 26, 2010; DOI: 10.3171/2010.2.JNS091528.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Brain atlas of structure and vasculature.

  • View in gallery

    Superior-posterior view of 3D stereotactic target structures: STN, VIM, and GPi. An orientation box appears in the upper left corner.

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    User interface of the simulator showing the atlas manipulation panel (upper); anatomical and vascular indices (right) with cortical areas and subcortical structures (upper), arteries (center), and veins and dural sinuses (lower). Note the DBS simulation control panel for target selection, trajectory planning, 3D display, and penetration calculation (left).

  • View in gallery

    Process of simulation illustrated for left subthalamic stimulation. A: Atlas-assisted targeting with the PFA (PFA targeting probability is 0.99). The ventricular system and surrounding subcortical structures are also shown. B: Entry point of stereotactic trajectory placed on middle frontal gyrus (without using the vascular atlas). The gyri are labeled. C: Calculation of the vessels intersected by the DBS electrode for the trajectory planned (that is, without using the vascular atlas) with the list of all intersected vessels (right). Some intersected vessels are labeled with names and diameters. D: Atlas-assisted placement of DBS electrode without vessel penetration. The orientation of each view is shown in the top left corner of each panel. A = anterior; I = inferior; L = left; P = posterior; R = right; S = superior.

  • View in gallery

    Morphological images—1.5-T T1-weighted (A), 1.5-T T2-weighted (B), and 3-T T1-weighted (C)—obtained at the level of the foramen of Monro. Note that morphological images typically acquired in SFN poorly depict the vasculature.

  • View in gallery

    Angiographic images—1.5-T 2D TOF (A), 1.5-T 3D TOF (B), and 3-T 3D TOF (C)—obtained at the level of the foramen of Monro demonstrating the vasculature. The 3D 3-T TOF images are superior to the 1.5-T 2D and 3D TOF acquisitions.

  • View in gallery

    Images obtained on 7-T unit at the level of the foramen of Monro—TOF (A), SPGR (B), and susceptibility weighted (C)—showing the vessels in great detail, particularly on susceptibility weighted imaging. The SPGR acquisitions demonstrate both the anatomy and the vasculature.

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