title: Interventional magnetic resonance guidance of deep brain stimulator implantation for Parkinson disease.
abstract: Deep brain stimulation is increasingly being applied to movement disorders, and other novel applications are emerging. The therapy requires precise localization of the stimulation electrode at specific target sites in deep brain structures. Conventional means of implantation rely on stereotactic approaches, which lack sufficient targeting accuracy and therefore are supported by invasive physiological mapping. We review the use of interventional magnetic resonance image guidance for the implantation of deep brain stimulator electrodes in patients with moderate to advanced Parkinson disease. The methodologies used in this innovative surgical technique are presented, along with the potential benefits and limitations of such an approach. Targeting accuracies are shown to be within approximately 1 mm of the intended deep brain structure and are achieved with a single brain penetration in most cases. Preliminary evaluation of clinical outcomes indicates comparable results to that achieved with conventional implantation methods, and the technique holds promise for substantially reducing operative durations.
authors.affiliation: Departments of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, CA 94143, USA. amartin@radiology.ucsf.edu
authors.forename: Alastair J
authors.initials: AJ
authors.lastname: Martin
authors.forename: Paul S
authors.initials: PS
authors.lastname: Larson
authors.forename: Jill L
authors.initials: JL
authors.lastname: Ostrem
authors.forename: Philip A
authors.initials: PA
authors.lastname: Starr
mesh_terms: D000328:Adult; D000368:Aged; D003399:Craniotomy / Q000379:methods*; D046690:Deep Brain Stimulation / Q000295:instrumentation* / Q000379:methods; D004567:Electrodes, Implanted; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000295:instrumentation / Q000379:methods; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000473:pathology* / Q000534:rehabilitation*; D018579:Patient Selection; D025321:Surgery, Computer-Assisted / Q000295:instrumentation / Q000379:methods*; D016896:Treatment Outcome