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    Home > Active Ingredient News > Study of Nervous System > JPD: Zhejiang University: Neuroimaging Assists Deep Brain Stimulation for Parkinson's Disease

    JPD: Zhejiang University: Neuroimaging Assists Deep Brain Stimulation for Parkinson's Disease

    • Last Update: 2022-04-21
    • Source: Internet
    • Author: User
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    Deep brain stimulation (DBS) of the hypothalamic nucleus (STN) is a globally recognized neuromodulation method for the treatment of Parkinson's disease (PD)
    .
    To date, there are several methods of electrode implantation, including preoperative imaging guidance, intraoperative test-assisted microelectrode recording (MER), and methods for intraoperative computed tomography (CT) or magnetic resonance imaging (MRI) validation

    .





    In previous studies, MER was considered an effective approach to target the STN region in DBS surgery
    .
    As image-guided DBS surgery has experienced significant growth in recent decades, it has been suggested that MER is not a necessary approach for STN-DBS

    .
    Image-guided localization also raised the possibility of DBS during sleep

    .
    Given the level of stress and discomfort, patients with peritonitis prefer to perform surgery while sleeping rather than awake

    .


    However, intraoperative CT or MRI facilities for confirming electrode placement are not widely available, especially in developing countries
    .
    Therefore, it is crucial to obtain an estimated success rate of STN localization only by preoperative MRI

    .



    The accuracy of targeting was strongly related to the outcome of STN-DBS in improving symptoms
    .
    Different implantation methods at different medical centers reported varying degrees of targeting accuracy

    .
    Several factors are known to play a role in targeting accuracy, such as the stereotaxic system used, the target site, and brain metastases due to cerebrospinal fluid loss and intracranial air

    .
    Here, we propose that MER can serve as a predictor of targeting accuracy during STN-DBS

    .

    Hereby, Zhe Zhenga et al.
    , of the Second Affiliated Hospital of Zhejiang University, retrospectively analyzed single-center data from patients who received awake STN-DBS to explore implantation success rates based on preoperative imaging alone, and those obtained by surgery alone.
    Targeting accuracy of ex-imaging versus MER-guided surgery

    .

    They performed a retrospective analysis of 161 Parkinson's disease patients who underwent STN-DBS at our center from March 2013 to June 2021
    .
    Implantation was performed by direct magnetic resonance imaging (MRI)-based localization preoperatively, with intraoperative MER and macrostimulation testing

    .
    285 electrode trajectories including preoperative and postoperative coordinates were included to calculate placement error for STN targeting

    .

    Under preoperative MRI guidance, 85.
    9% of electrodes were implanted without intraoperative adjustments

    .
    Thirty-one (10.
    2%) and 12 (3.
    9%) electrodes underwent intraoperative adjustments for MER and intraoperative testing, respectively

    .

    They found that 86.
    2% (245/285) of electrodes had track errors ≤2 mm

    .
    In the MER physiological signal length <4 mm and ≥4 mm groups, 38.
    0% and 8.
    8% of electrodes had track errors >2 mm, respectively

    .

    The final positioning of the MER-adjusted electrodes is offset from the center of the STN compared to the unadjusted electrodes
    .

    The final positioning of the MER-adjusted electrodes is offset from the center of the STN compared to the unadjusted electrodes
    .

    The significance of this study lies in its findings: As a result of preoperative MRI-guided STN localization, electrodes need to be repositioned in approximately 14% of cases
    .
    The length of the MER physiological signal was <4 mm at the first penetration, implying a deviation from the planned target
    .
    MER combined with intraoperative sobriety testing can help rescue this MRI-only deviation

    .

    As a result of preoperative MRI-guided STN localization, electrode repositioning was required in approximately 14% of cases
    .

     


    Original source:
    Zheng Z, Zhu Z, Ying Y, et al.
    The Accuracy of Imaging Guided Targeting with Microelectrode Recoding in Subthalamic Nucleus for Parkinson's Disease: A Single-Center Experience.



    The Accuracy of Imaging Guided Targeting with Microelectrode Recoding in Subthalamic Nucleus for Parkinson's Disease: A Single-Center Experience.

     

     



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