Artikel
In vivo ultra high-field tractography and subdivision of the human subthalamic nucleus to improve deep brain stimulation
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Autoren
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Sonny K. H. Tan
- Department of Neurosurgery, Uniklinik RWTH Aachen, Germany; Department of Neuroscience, Maastricht University, Maastricht, The Netherlands
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Birgit Plantinga
- Department of Neuroscience, Maastricht University, Maastricht, The Netherlands; Biomedical Image Analysis, Eindhoven University of Technology, Eindhoven, The Netherlands
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Anke Höllig
- Department of Neurosurgery, Uniklinik RWTH Aachen, Germany
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Björn Falkenburger
- Department of Neurology, Uniklinik RWTH Aachen, Germany
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Mark Kuijf
- Department of Neurology, Maastricht University Medical Center, Maastricht, The Netherlands
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Hans Clusmann
- Department of Neurosurgery, Uniklinik RWTH Aachen, Germany
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Yasin Temel
- Department of Neuroscience, Maastricht University, Maastricht, The Netherlands; Department of Neurosurgery, Maastricht University Medical Center, Maastricht, The Netherlands
| Veröffentlicht: | 2. Juni 2015 |
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Gliederung
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Objective: The subthalamic nucleus (STN) is the preferred anatomical target for deep brain stimulation (DBS) in Parkinson’s disease. STN DBS alleviates motor symptoms, but may induce neuropsychiatric side-effects. These side-effects have been associated with a suboptimal position of the electrode within the STN. With current clinical MRI techniques, the small STN and especially its functional subdivisions, cannot be identified accurately enough to solely rely upon for targeting. With the introduction of ultra high-field (7T or higher) MRI scanners, images with higher resolution and contrast becomes available. This is important to improve selective targeting the motor region of the STN. In this study we investigate high-resolution structural connectivity of the STN and its functional subdivision based on 7T MRI data.
Method: Healthy subjects (age 57 - 70 years; n=4), were scanned on a 7T MRI scanner (Magnetom 7T, Siemens, Germany). The scan protocol consisted of 0.5 mm isotropic gradient echo (GE) and 1.5 mm isotropic diffusion weighted images with 60 directions with a b-value of 2000 s/mm2 and 6 additional b0 volumes. The STN was manually delineated from the GE images. They were then coregistered to the corrected diffusion weighted images using FSL’s linear image registration tool. Fiber tracking was performed from the STN using diffusion tensor based deterministic fiber tracking. Fibers with distinctly different destinations were manually selected to investigate their origin within the STN.
Results: Fibers emerging from the STN connected to the anteromedial side of the internal globus pallidus (GPi), the premotor cortical areas, and the frontotemporal cortical areas. The fibers running to the GPi emerged from the anteromedial side of the STN. The majority of the fibers running to the premotor areas originated from the posterolateral side of the STN. The majority of the fibers running to the frontotemporal areas emerged from the dorsolateral side of the STN.
Conclusions: These results showed a subdivision of the STN based on its structural connectivity. The connections of the anteromedial STN with the limbic anteromedial GPi and those of the posterolateral STN with the premotor cortical areas, suggest that the STN can be divided in a limbic anteromedial and a motor posterolateral part. These results also suggest that ultra high-field diffusion MRI may aid in improving the anatomical targeting of the STN for DBS surgery by accurate and subject specific identification of the functional area of interest.
