Article
Online fMRI for intraoperative monitoring of subcortical deep-brain stimulation
Online-fMRT zum intraoperativen Monitoring der subkortikalen Tiefenhirnstimulation
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Authors
Published: | April 23, 2004 |
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Outline
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Objective
To determine the intraoperative application of a 1,5 Tesla MRI for monitoring of functional-stereotactic surgical procedures und the application of real-time evaluation of fMRI (Turbo Brain Voyager, Brain Innovation, Maastricht).
Methods
From 02/1996 through 03/2003, 242 patients were treated with Deep-Brain stimulation for movement disorders in our institution. CT/MRI image fusion and computerized 3D-multiplanar treatment planning were used for stereotactic implantation of quadrupolar stimulation electrodes. In 6/242 cases with Parkinsons disease fMRI examinations were performed after unilateral placement (first side) of the electrode in the subthalamic nucleus. Patients were asked to press a ball with constant power during stimulation ON and stimulation OFF conditions. The magnitude of pressure was registered. Using an LED-scale the patient was informed about the pressure value. To simulate real-time conditions after surgery, in every case a set of raw data was taken for evaluation.
Results
Even though the results showed a great variability, this analysis displayed reproducibly an activation of the ventral basal ganglia during activity in the primary motor cortex, which was the result of muscle activation on the forearm. Both activation patterns and an estimate of mean activation values could be displayed in real-time with the Turbo Brain Voyager.
Conclusions
These first results show that the effects of Deep-Brain stimulation can be visualized with fMRI under real-time conditions. Highly specialised software for online evaluations provides conclusive data within a few minutes and subsequent intraoperative implementation of this information.