Lack of agreement between direct magnetic resonance imaging and statistical determination of a subthalamic target: the role of electrophysiological guidance

Emmanuel Cuny M.D. 1 , Dominique Guehl M.D., Ph.D. 1 , Pierre Burbaud M.D., Ph.D. 1 , Christian Gross Ph.D. 1 , Vincent Dousset M.D., Ph.D. 1 , and Alain Rougier M.D. 1
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  • 1 Service de Neurochirurgie, Service d'Exploration Fonctionnelle Neurologique, et Service de Neuroradiologie, Hôpital Pellegrin, Bordeaux, France
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Object. The goal of this study was to determine the most suitable procedure(s) to localize the optimal site for high-frequency stimulation of the subthalamic nucleus (STN) for the treatment of advanced Parkinson disease.

Methods. Stereotactic coordinates of the STN were determined in 14 patients by using three different methods: direct identification of the STN on coronal and axial T2-weighted magnetic resonance (MR) images and indirect targeting in which the STN coordinates are referred to the anterior commissure—posterior commissure (AC—PC) line, which, itself, is determined either by using stereotactic ventriculography or reconstruction from three-dimensional (3D) MR images. During the surgical procedure, electrode implantation was guided by single-unit microrecordings on multiple parallel trajectories and by clinical assessment of stimulations. The site where the optimal functional response was obtained was considered to be the best target. Computerized tomography scanning was performed 3 days later and the scans were combined with preoperative 3D MR images to transfer the position of the best target to the same system of stereotactic coordinates. An algorithm was designed to convert individual stereotactic coordinates into an all-purpose PC-referenced system for comparing the respective accuracy of each method of targeting, according to the position of the best target.

Conclusions. The target that is directly identified by MR imaging is more remote (mainly in the lateral axis) from the site of the optimal functional response than targets obtained using other procedures, and the variability of this method in the lateral and superoinferior axes is greater. In contrast, the target defined by 3D MR imaging is closest to the target of optimal functional response and the variability of this method is the least great. Thus, 3D reconstruction adjusted to the AC—PC line is the most accurate technique for STN targeting, whereas direct visualization of the STN on MR images is the least effective. Electrophysiological guidance makes it possible to correct the inherent inaccuracy of the imaging and surgical techniques and is not designed to modify the initial targeting.

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Contributor Notes

Address reprint requests to: Emmanuel Cuny, M.D., Service de Neurochirurgie, Hôpital Pellegrin, CHU de Bordeaux, Place Amélie-Raba-Léon, 33076 Bordeaux, France. email: emmanuel.cuny@chu-bordeaux.fr.
  • 1.

    Alterman RL, , Reiter GT, & Shils J, et al: Targeting for thalamic deep brain stimulator implantation without computer guidance: assessment of targeting accuracy. Stereotact Funct Neurosurg 72:150153, 1999 Alterman RL, Reiter GT, Shils J, et al: Targeting for thalamic deep brain stimulator implantation without computer guidance: assessment of targeting accuracy. Stereotact Funct Neurosurg 72:150–153, 1999

    • Search Google Scholar
    • Export Citation
  • 2.

    Bejjani BP, , Dormont D, & Pidoux B, et al: Bilateral subthalamic stimulation for Parkinson's disease by using three-dimensional stereotactic magnetic resonance imaging and electrophysiological guidance. J Neurosurg 92:615625, 2000 Bejjani BP, Dormont D, Pidoux B, et al: Bilateral subthalamic stimulation for Parkinson's disease by using three-dimensional stereotactic magnetic resonance imaging and electrophysiological guidance. J Neurosurg 92:615–625, 2000

    • Search Google Scholar
    • Export Citation
  • 3.

    Benabid AL, , Krack PP, & Benazzouz A, et al: Deep brain stimulation of the subthalamic nucleus for Parkinson's disease: methodologic aspects and clinical criteria. Neurology 55 (Suppl 6):S40S44, 2000 Benabid AL, Krack PP, Benazzouz A, et al: Deep brain stimulation of the subthalamic nucleus for Parkinson's disease: methodologic aspects and clinical criteria. Neurology 55 (Suppl 6):S40–S44, 2000

    • Search Google Scholar
    • Export Citation
  • 4.

    Benabid AL, , Pollack P, & Benazzouz A, et al: Grenoble guidelines for deep brain stimulation, in First European Symposium on Stimulation in Parkinson Disease. Grenoble, France: Université Joseph Fourier de Grenoble, 1998, p 13 Benabid AL, Pollack P, Benazzouz A, et al: Grenoble guidelines for deep brain stimulation, in First European Symposium on Stimulation in Parkinson Disease. Grenoble, France: Université Joseph Fourier de Grenoble, 1998, p 13

    • Search Google Scholar
    • Export Citation
  • 5.

    Benabid AL, , Pollak P, & Louveau A, et al: Combined (thalamotomy and stimulation) stereotactic surgery of the VIM thalamic nucleus for bilateral Parkinson disease. Appl Neurophysiol 50:344346, 1987 Benabid AL, Pollak P, Louveau A, et al: Combined (thalamotomy and stimulation) stereotactic surgery of the VIM thalamic nucleus for bilateral Parkinson disease. Appl Neurophysiol 50:344–346, 1987

    • Search Google Scholar
    • Export Citation
  • 6.

    Carlson JD, & Iacono RP: Electrophysiological versus image-based targeting in the posteroventral pallidotomy. Comput Aided Surg 4:93100, 1999 Carlson JD, Iacono RP: Electrophysiological versus image-based targeting in the posteroventral pallidotomy. Comput Aided Surg 4:93–100, 1999

    • Search Google Scholar
    • Export Citation
  • 7.

    Dormont D, , Cornu P, & Pidoux B, et al: Chronic thalamic stimulation with three-dimensional MR stereotactic guidance. AJNR 18:10931107, 1997 Dormont D, Cornu P, Pidoux B, et al: Chronic thalamic stimulation with three-dimensional MR stereotactic guidance. AJNR 18:1093–1107, 1997

    • Search Google Scholar
    • Export Citation
  • 8.

    Forster A, , Eljamel MS, & Varma TR, et al: Audit of neurophysiological recording during movement disorder surgery. Stereotact Funct Neurosurg 72:154156, 1999 Forster A, Eljamel MS, Varma TR, et al: Audit of neurophysiological recording during movement disorder surgery. Stereotact Funct Neurosurg 72:154–156, 1999

    • Search Google Scholar
    • Export Citation
  • 9.

    Gross C, , Rougier A, & Guehl D, et al: High-frequency stimulation of the globus pallidus internalis in Parkinson's disease: a study of seven cases. J Neurosurg 87:491498, 1997 Gross C, Rougier A, Guehl D, et al: High-frequency stimulation of the globus pallidus internalis in Parkinson's disease: a study of seven cases. J Neurosurg 87:491–498, 1997

    • Search Google Scholar
    • Export Citation
  • 10.

    Gross CE, , Boraud T, & Cuny E, et al: Per-operative single unit recording of subthalamic neurons in parkinsonian patients: characteristics of discharge. Mov Disord 15 (Suppl 3):P381, 2000 (Abstract) Gross CE, Boraud T, Cuny E, et al: Per-operative single unit recording of subthalamic neurons in parkinsonian patients: characteristics of discharge. Mov Disord 15 (Suppl 3):P381, 2000 (Abstract)

    • Search Google Scholar
    • Export Citation
  • 11.

    Gross RE, , Lombardi WJ, & Hutchison WD, et al: Variability in lesion location after microelectrode-guided pallidotomy for Parkinson's disease: anatomical, physiological, and technical factors that determine lesion distribution. J Neurosurg 90:468477, 1999 Gross RE, Lombardi WJ, Hutchison WD, et al: Variability in lesion location after microelectrode-guided pallidotomy for Parkinson's disease: anatomical, physiological, and technical factors that determine lesion distribution. J Neurosurg 90:468–477, 1999

    • Search Google Scholar
    • Export Citation
  • 12.

    Kirschman DL, , Milligan B, & Wilkinson S, et al: Pallidotomy microelectrode targeting: neurophysiology-based target refinement. Neurosurgery 46:613624, 2000 Kirschman DL, Milligan B, Wilkinson S, et al: Pallidotomy microelectrode targeting: neurophysiology-based target refinement. Neurosurgery 46:613–624, 2000

    • Search Google Scholar
    • Export Citation
  • 13.

    Lemaire JJ, , Durif F, & Boire JY, et al: Direct stereotactic MRI location in the globus pallidus for chronic stimulation in Parkinson's disease. Acta Neurochir 141:759766, 1999 Lemaire JJ, Durif F, Boire JY, et al: Direct stereotactic MRI location in the globus pallidus for chronic stimulation in Parkinson's disease. Acta Neurochir 141:759–766, 1999

    • Search Google Scholar
    • Export Citation
  • 14.

    Limousin P, , Krack P, & Pollak P, et al: Electrical stimulation of the subthalamic nucleus in advanced Parkinson's disease. N Engl J Med 339:11051111, 1998 Limousin P, Krack P, Pollak P, et al: Electrical stimulation of the subthalamic nucleus in advanced Parkinson's disease. N Engl J Med 339:1105–1111, 1998

    • Search Google Scholar
    • Export Citation
  • 15.

    Limousin P, , Pollak P, & Benazzouz A, et al: Effect of parkinsonian signs and symptoms of bilateral subthalamic nucleus stimulation. Lancet 345:9195, 1995 Limousin P, Pollak P, Benazzouz A, et al: Effect of parkinsonian signs and symptoms of bilateral subthalamic nucleus stimulation. Lancet 345:91–95, 1995

    • Search Google Scholar
    • Export Citation
  • 16.

    Merello M, , Cammarota A, & Cerquetti D, et al: Mismatch between electrophysiologically defined and ventriculography based theoretical targets for posteroventral pallidotomy in Parkinson's disease. J Neurol Neurosurg Psychiatry 69:787791, 2000 Merello M, Cammarota A, Cerquetti D, et al: Mismatch between electrophysiologically defined and ventriculography based theoretical targets for posteroventral pallidotomy in Parkinson's disease. J Neurol Neurosurg Psychiatry 69:787–791, 2000

    • Search Google Scholar
    • Export Citation
  • 17.

    Mobin F, , De Salles AA, & Behnke EJ, et al: Correlation between MRI-based stereotactic thalamic deep brain stimulation electrode placement, macroelectrode stimulation and clinical response to tremor control. Stereotact Funct Neurosurg 72:225232, 1999 Mobin F, De Salles AA, Behnke EJ, et al: Correlation between MRI-based stereotactic thalamic deep brain stimulation electrode placement, macroelectrode stimulation and clinical response to tremor control. Stereotact Funct Neurosurg 72:225–232, 1999

    • Search Google Scholar
    • Export Citation
  • 18.

    Schuurman PR, , de Bie RM, & Majoie CB, et al: A prospective comparison between three-dimensional magnetic resonance imaging and ventriculography for target-coordinate determination in frame-based functional stereotactic neurosurgery. J Neurosurg 91:911914, 1999 Schuurman PR, de Bie RM, Majoie CB, et al: A prospective comparison between three-dimensional magnetic resonance imaging and ventriculography for target-coordinate determination in frame-based functional stereotactic neurosurgery. J Neurosurg 91:911–914, 1999

    • Search Google Scholar
    • Export Citation
  • 19.

    Voges J, , Volkmann J, & Allert N, et al: Bilateral high-frequency stimulation in the subthalamic nucleus for the treatment of Parkinson disease: correlation of therapeutic effect with anatomical electrode position. J Neurosurg 96:269279, 2002 Voges J, Volkmann J, Allert N, et al: Bilateral high-frequency stimulation in the subthalamic nucleus for the treatment of Parkinson disease: correlation of therapeutic effect with anatomical electrode position. J Neurosurg 96:269–279, 2002

    • Search Google Scholar
    • Export Citation

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