Neuronavigation using susceptibility-weighted venography: application to deep brain stimulation and comparison with gadolinium contrast.
Careful trajectory planning on preoperative vascular imaging is an essential step in deep brain stimulation (DBS) to minimize risks of hemorrhagic complications and postoperative neurological deficits. This paper compares 2 MRI methods for visualizing cerebral vasculature and planning DBS probe trajectories: a single data set T1-weighted scan with double-dose gadolinium contrast (T1w-Gd) and a multi-data set protocol consisting of a T1-weighted structural, susceptibility-weighted venography, and time-of-flight angiography (T1w-SWI-TOF). Two neurosurgeons who specialize in neuromodulation surgery planned bilateral STN DBS in 18 patients with Parkinson's disease (36 hemispheres) using each protocol separately. Planned trajectories were then evaluated across all vascular data sets (T1w-Gd, SWI, and TOF) to detect possible intersection with blood vessels along the entire path via an objective vesselness measure. The authors' results show that trajectories planned on T1w-SWI-TOF successfully avoided the cerebral vasculature imaged by conventional T1w-Gd and did not suffer from missing vascular information or imprecise data set registration. Furthermore, with appropriate planning and visualization software, trajectory corridors planned on T1w-SWI-TOF intersected significantly less fine vasculature that was not detected on the T1w-Gd (p < 0.01 within 2 mm and p < 0.001 within 4 mm of the track centerline). The proposed T1w-SWI-TOF protocol comes with minimal effects on the imaging and surgical workflow, improves vessel avoidance, and provides a safe cost-effective alternative to injection of gadolinium contrast.
McConnell Brain Imaging Centre and.
Silvain
S
Bériault
Abbas F
AF
Sadikot
Fahd
F
Alsubaie
Simon
S
Drouin
D Louis
DL
Collins
G Bruce
GB
Pike
D000328:Adult; D000368:Aged; D001921:Brain / Q000601:surgery*; D003287:Contrast Media; D046690:Deep Brain Stimulation / Q000379:methods*; D005260:Female; D005682:Gadolinium; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D038361:Neuronavigation / Q000379:methods*; D010690:Phlebography / Q000379:methods*
D003287:Contrast Media; D005682:Gadolinium
DBS = deep brain stimulation; IBIS = Interactive Brain Imaging System; MER = microelectrode recording; MIP = maximum intensity projection; PD = Parkinson's disease; STN = subthalamic nucleus; SWI = susceptibility-weighted imaging; T1w = T1-weighted; TOF = time of flight; computer-assisted intervention; deep brain stimulation; functional neurosurgery; mIP = minimum intensity projection; presurgical planning; susceptibility-weighted imaging