gms | German Medical Science

57th Annual Meeting of the German Society of Neurosurgery
Joint Meeting with the Japanese Neurosurgical Society

German Society of Neurosurgery (DGNC)

11 - 14 May, Essen

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Fiber tracking improves the accuracy of subthalamic nucleus (STN) targeting in deep brain stimulation (DBS)

Faserdarstellung verbessert die Genauigkeit der Zielfindung im Nucleus subthalamicus bei der Tiefenhirnstimulation

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  • corresponding author A. Brentrup - Westfälische Wilhelms-Universität, Klinik und Poliklinik für Neurochirurgie, Münster
  • F. Möllmann - Westfälische Wilhelms-Universität, Klinik und Poliklinik für Neurochirurgie, Münster
  • H. Kugel - Westfälische Wilhelms-Universität, Institut für klinische Radiologie, Münster
  • H.W. Bothe - Westfälische Wilhelms-Universität, Klinik und Poliklinik für Neurochirurgie, Münster

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 57. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie. Essen, 11.-14.05.2006. Düsseldorf, Köln: German Medical Science; 2006. DocP 03.41

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/dgnc2006/06dgnc258.shtml

Published: May 8, 2006

© 2006 Brentrup et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Objective: The success of DBS surgery for Parkinson´s disease depends on accuracy in target determination within the dorsal aspect of the STN. The direct targeting is hampered by the windowing depending STN borders on a T2-weighted image. The STN borders medially and dorsally on the zona incerta (ZI), laterally on the pyramidal tract (PT). With respect to the anatomical features the purpose of our study is to compare the effect of targeting with and without fiber tracking of ZI and PT on the postoperative motor score.

Methods: We randomized 8 patients suffering from Parkinson´s disease (7 men, 1 woman, average age 61, range 54-78). The following MR sequences were obtained preoperatively: MPRANGE with contrast medium, T2-weighted images, and diffusion weighted images. Preoperative planning (targets, trajectories, and fibers of ZI and PT) were performed on a BrainLab® workstation. After stereotactic implantation of DBS leads (Medtronic® 3389) on both sides we fused a postoperative computertomography (CT) with the preoperative planning to control the localization of contacts. After adjustment of stimulation parameters UPDRS motor score were determined 4 weeks after implantation.

Results: Means of preoperative motor scores (OFF) were 56 (SD±7) for targeting without fiber tracking and 53 (SD±5) for targeting including fiber tracking, respectively. Means of postoperative motor score (stimulation ON, unchanged levodopa therapy) were 21 (SD±4) for targeting without tracking and 16 (SD±5) using targeting with fiber tracking.

Conclusions: Fiber tracking shows a tendency to become a useful tool for enhancing the accuracy of STN targeting which results in better postoperative motor scores.