The role of modern imaging modalities on deep brain stimulation targeting for mental illness.
BACKGROUND
The reversible nature of deep brain stimulation (DBS) brought renewed interest on surgery to medically intractable mental illnesses. The explosion of anatomical and functional imaging has allowed the development of new potential targets and the understanding of historical targets.


METHODS
Fifteen patients undergoing stereotactic surgery for movement disorders, at UCLAs interventional MRI operating-room, were studied with fiber tracking. Stereotactic targets and fiber tracking were determined on MRIs using the Schaltenbrand-Wahren atlas for definition in the iPlan software. Cingulate, subcaudate, BA25/CgWM, amygdala, posterior hypothalamus, orbitofrontal cortex, nucleus accumbens, anterior limb of the internal capsule and dorsomedial thalamus were studied. DTI parameters used ranged from 10 to 20mm for voxel size in the x/y/z planes, fiber length was kept constant at 36 mm, and fractional anisotropy (FA) threshold varied from 0.20 to 0.25.


RESULTS
Reliable interconnectivity of targets were determined with DTI and related to PET imaging. Mental illness targets were observed with functional and fiber tract maps. This confirmation yields reliability to DTI imaging in order to determine novel targets and enhance the understanding of areas not well understood.


CONCLUSIONS
Currently available imaging techniques, the reversibility of DBS to modulate targets promises to bring a brighter future for surgery of mental illness.
Sedrak
M
M
Division of Neurosurgery, David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, CA, USA.
Gorgulho
A
A
De Salles
A F
AF
Frew
A
A
Behnke
E
E
Ishida
W
W
Klochkov
T
T
Malkasian
D
D
D000293:Adolescent; D000328:Adult; D000368:Aged; D016880:Anisotropy; D001921:Brain / Q000473:pathology / Q000528:radiation effects; D046690:Deep Brain Stimulation / Q000379:methods*; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008297:Male; D001523:Mental Disorders / Q000473:pathology / Q000628:therapy*; D008875:Middle Aged; D013238:Stereotaxic Techniques; D025321:Surgery, Computer-Assisted