Article
Probabilistic maps as a tool for orthogonal targeting of the nucleus basalis of Meynert for deep brain stimulation in Alzheimer’s disease
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Authors
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Pablo Andrade
- Department of Stereotaxy and Functional Neurosurgery, University of Cologne, Cologne; Department of Neurosurgery, University of Cologne, Cologne
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Alexandra Hellerbach
- Department of Stereotaxy and Functional Neurosurgery, University of Cologne, Cologne
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Harald Treuer
- Department of Stereotaxy and Functional Neurosurgery, University of Cologne, Cologne
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Svenja Caspers
- Institute of Neuroscience and Medicine INM-1, Research Center Jülich, Jülich
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Karl Zilles
- Institute of Neuroscience and Medicine INM-1, Research Center Jülich, Jülich
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Veerle Visser-Vandewalle
- Department of Stereotaxy and Functional Neurosurgery, University of Cologne, Cologne
| Published: | June 2, 2015 |
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Outline
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Objective: Probabilistic maps from specific structures of the brain based on molecular and imaging datasets are a valuable instrument that could reinforce or substitute the use of current neuroanatomical atlases. The severe reduction of cholinergic neurons observed in Alzheimer’s disease patients is considered to be part of the pathogenesis of the disease. One of the aims of this study is to develop a realistic anatomical three-dimensional model of the nucleus basalis of Meynert (the predominant cholinergic structure in the basal forebrain) for stereotactic implantation of electrodes for deep brain stimulation in patients with Alzheimer’s disease. The second objective of this report is to establish the feasibility of an orthogonal approach of the nucleus basalis of Meynert, in order to reduce the lateral variability of electrode implantation on this horizontally distributed structure.
Method: We evaluated the volumetric data obtained from previously dissected human brains. The histological analysis included the molecular staining of cholinergic neurons of the nucleus basalis of Meynert (Ch4) and the septal nucleus and the diagonal band of Broca (Ch1-3). The resulting volume of interest of each brain was digitalized and then tested for interindividual differences and variability compared to the rest of the population. Finally, the resulting datasets were spatially transformed and superimposed on standard magnetic resonance images, in order to plan the trajectory of the electrode implantation.
Results: The datasets of all human brains included in this study could show an extent of the areas for a probability between 35 and 100%. These anatomical reconstructions could be dynamically adapted for a maximum probability of 90 to 100%, with the consequent disadvantage of a reduced volume of interest. For the planning of our orthogonal approach we calculated a maximum probability of 60%. After using these parameters, an orthogonal approach covering the majority of the nucleus with a horizontal orientation was possible. As far as 11-12mm of the distance of an electrode could be introduced into the nucleus for stimulation.
Conclusions: This study shows that probability maps can be used as a genuine tool for targeting and stereotactic planning. Furthermore, the results of this study suggest that an orthogonal implantation of electrodes for deep brain stimulation of the nucleus basalis of Meynert may be feasible for Alzheimer’s disease patients.
