Article
Sensitivity and specificity of FLAIR-3T-MRI dependent visualization of the nucleus subthalamicus for deep brain stimulation
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Authors
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Witold Polanski
- Klinik und Poliklinik für Neurochirurgie, Medizinische Fakultät 'Carl Gustav Carus' der TU Dresden
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Kay Engellandt
- Abteilung Neuroradiologie, Medizinische Fakultät 'Carl Gustav Carus' der TU Dresden
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Lisa Klingelhoefer
- Klinik und Poliklinik für Neurologie, Medizinische Fakultät 'Carl Gustav Carus' der TU Dresden
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Alexander Storch
- Klinik und Poliklinik für Neurologie, Medizinische Fakultät 'Carl Gustav Carus' der TU Dresden
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Gabriele Schackert
- Klinik und Poliklinik für Neurochirurgie, Medizinische Fakultät 'Carl Gustav Carus' der TU Dresden
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Stephan B. Sobottka
- Klinik und Poliklinik für Neurochirurgie, Medizinische Fakultät 'Carl Gustav Carus' der TU Dresden
| Published: | May 21, 2013 |
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Outline
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Objective: Successful deep brain stimulation (DBS) of the nucleus subthalamicus (STN) is mostly dependent on an accurate position of the leads at the optimal target point. Till now, DBS in local anesthesia (LA) with intraoperative testing and microelectrode recordings (MER) is the gold standard. Since recent development of high field strength MRI allows an exact localization of the STN, it may be questionable if intraoperative testing and MER in LA are still necessary to achieve optimal clinical results. Therefore, we investigated, whether the visualization of the STN in Fluid Attenuated Inversion Recovery (FLAIR)-3T-MRI correlates with intraoperative MER.
Method: In 15 patients the extent of the STN was independently evaluated by one neuroradiologist and two neurosurgeons using a FLAIR-3T-MRI. After lead placement into the STN in LA with MER and intraoperative examination, we merged preoperative MRI with postoperative computer tomography scans (CT) to determine the exact position of the leads. Then, after reconstruction of the intraoperative MER leads by defining trajectories into the MRI, the position of the four electrodes in every implanted lead was simulated and evaluated, whether they would be located in the STN. Medtronic lead configuration (model 3389) was used as reference.
Results: There were used 132 MER-leads in 15 patients with STN-DBS in LA. Consequently, 528 electrode positions were evaluated for clear MER signal of the STN and for localization in FLAIR-3T-MRI. 199 electrodes showed a positive STN signal in MER, while 34 of them were not located in the STN in MRI. On the other hand, 270 of 329 electrodes were not located in the STN in MRI and in MER. In FLAIR-3T-MRI, 224 electrodes were located in the STN, but only 165 of these electrodes showed a clear positive signal for STN in MER. Further, 304 electrodes were not located in the STN in MRI while 34 of these electrodes showed still a STN signal in MER. This study revealed a sensitivity of 82.9% and a specificity of 82.1% for MRI based STN localization. The positive and negative predictive value was 73.7% and 88.8%, respectively.
Conclusions: The FLAIR-3T-MRI based STN localization shows a good sensitivity and specificity but seems to be not sufficient enough for isolated determination of the optimal target. Therefore we conclude that it may be favorable to use MER and intraoperative clinical testing in LA despite high resolution MRI alone to achieve an optimal targeting in STN-DBS, unless there are no reasons, which forbid LA.
