Multiple sequential image-fusion and direct MRI localisation of the subthalamic nucleus for deep brain stimulation.
OBJECTIVE
Deep brain stimulation (DBS) is the treatment of choice for advanced Parkinson's disease. The target co-ordinates are traditionally calculated in relation to the intercommissural distance. Anterior (AC) and posterior commissures (PC) may be visualised by the means of ventriculography, CT or MRI.


METHODS
We have studied the efficacy of direct visualisation of the subthalamic-red nucleus complex on MRI, the advantage of fusion of stereotactic CT and MR images (Multiple Sequences Image Fusion - MuSIF). These methods are combined with double check of indirect calculation of the target co-ordinates based on AC-PC line, as well as the corrispondence to the stereotactic electronic atlas.


RESULTS
Subthalamic nucleus (STN) was well recognisable in fused images in all 22 sides. At 3 months from surgery it was possible to reduce 76% of L-dopa equivalent daily dose. Dyskine-sias reduced to 50% and motor fluctuation up to 45%.


CONCLUSIONS
In our experience MuSIF offers very high rate of accuracy in calculation of target co-ordinates. Direct visualisation of STN in MR and MuSIF are reliable and facilitate the accuracy of identification of target co-ordinates. Intraoperative neurophysiological recording increases the accuracy of microelectrode position.
Rampini
P M
PM
Neurosurgical Operative Unit, Department of Neurological Sciences, IRCCS Maggiore Polyclinic Hospital, University of Milan, Milan, Italy. rampini@policlinico.mi.it
Locatelli
M
M
Alimehmeti
R
R
Tamma
F
F
Caputo
E
E
Priori
A
A
Pesenti
A
A
Rohr
M
M
Egidi
M
M
D000978:Antiparkinson Agents / Q000008:administration & dosage; D004305:Dose-Response Relationship, Drug; D004599:Electric Stimulation Therapy; D006801:Humans; D007980:Levodopa / Q000008:administration & dosage; D008279:Magnetic Resonance Imaging; D008297:Male; D010300:Parkinson Disease / Q000175:diagnosis* / Q000188:drug therapy / Q000628:therapy*; D011184:Postoperative Period; D012012:Red Nucleus / Q000473:pathology; D013238:Stereotaxic Techniques; D020531:Subthalamic Nucleus / Q000000981:diagnostic imaging* / Q000473:pathology*; D014057:Tomography, X-Ray Computed
D000978:Antiparkinson Agents; D007980:Levodopa