目的:中央中核(CM)的深部脑刺激(DBS)用于治疗包括癫痫在内的多种脑部疾病,Tourette综合征,和意识障碍。然而,CM在常规MRI上可视化是具有挑战性的。许多外科医生使用基于已建立的立体定向坐标的间接靶向方法。作者旨在量化使用这种方法在CM内放置DBS电极触点的频率,并识别更准确的替代间接坐标。
方法:对健康成人获得的100张MR图像进行了CM的间接靶向,得到的坐标被扭曲成一个共同的大脑模板。要估计DBS触点沿此轨迹的位置,作者开发了一种可能的电极定位(PEL)掩模,从先前的临床病例中获得的轨迹角度建模。欧几里得和x,y,测量PEL掩模和基于图集的CM掩模的质心之间的z距离并将其定义为误差。确定PEL掩模和附近丘脑核之间的重叠百分比。为了评估这种方法的临床实用性,使用在全身性癫痫患者中获得的20张MR图像验证了该分析,CM-DBS的常见临床指征。
结果:使用标准间接坐标,作者发现平均欧氏误差为4.40±1.05mm,x,y,z误差为4.19±0.97mm,0.73±0.65mm,和0.66±0.69毫米,分别。PEL面罩与CM重叠为52%,与腹后内侧核重叠为65%。第三心室宽度的变化是这些错误的主要原因(r=-0.71)。为了克服这种变化,作者开发了替代间接坐标:后连合水平第三脑室后外侧角外侧4.5mm.有了这个细化,平均欧氏误差降低到1.24±0.5mm,在CM内使用84%的PEL面罩。
结论:无法直接靶向的高级MRI限制了在资源受限的神经外科计划中获得CM-DBS。标准间接坐标不能提供CM的最佳目标,大多数接触横向放置在感觉丘脑中。因此,所提出的间接方法可以提高CM-DBS的准确性和可用性,同时减少副作用。
OBJECTIVE: Deep brain stimulation (DBS) of the centromedian nucleus (CM) is used to treat diverse brain diseases including epilepsy, Tourette syndrome, and disorders of consciousness. However, the CM is challenging to visualize on routine MRI. Many surgeons use an indirect targeting method based on established stereotactic coordinates. The authors aimed to quantify how often a DBS electrode\'s contacts were positioned within the CM using this approach, and to identify alternative indirect coordinates that are more accurate.
METHODS: Indirect targeting of the CM was performed on 100 MR images obtained in healthy adults, and the resulting coordinates were warped to a common brain template. To estimate positions of DBS contacts along this trajectory, the authors developed a probable electrode location (PEL) mask, modeled on trajectory angles obtained from prior clinical cases. Euclidean and x, y, and z distances between the centroids of the PEL mask and an atlas-based CM mask were measured and defined as error. The percentage of overlaps between the PEL mask and nearby thalamic nuclei was determined. To assess the clinical utility of this methodology, the analysis was validated using 20 MR images obtained in patients with generalized epilepsy, a common clinical indication for CM-DBS.
RESULTS: Using standard indirect coordinates, the authors found the average Euclidean error to be 4.40 ± 1.05 mm, and the x, y, and z errors were 4.19 ± 0.97 mm, 0.73 ± 0.65 mm, and 0.66 ± 0.69 mm, respectively. The PEL mask overlap was 52% with the CM and 65% with the ventral posteromedial nucleus. Variation in third ventricular width was the dominant contributor to these errors (r = -0.71). To overcome this variation, the authors developed alternative indirect coordinates: 4.5 mm lateral to the posterolateral corner of the third ventricle at the level of the posterior commissure. With this refinement, the average Euclidean error was reduced to 1.24 ± 0.5 mm, with 84% of the PEL mask within the CM.
CONCLUSIONS: The unavailability of advanced MRI for direct targeting limits access to CM-DBS in resource-constrained neurosurgical programs. Standard indirect coordinates do not provide optimal targeting of the CM, with most contacts laterally placed in the sensory thalamus. The proposed indirect approach may therefore increase the accuracy and availability of CM-DBS, while reducing side effects.