title: Easy methods to make the neuronavigated targeting of DLPFC accurate and routinely accessible for rTMS.
abstract: OBJECTIVE
  Dorsolateral prefrontal cortex (DLPFC) is the main stimulation target for rTMS treatment of depression. DLPFC is located in the middle frontal gyrus and corresponds to the lateral part of Brodmann Areas 9 and 46. Current methods to locate the DLPFC are either based on head landmarks that are inaccurate, or based on MRI-neuronavigation. Neuronavigated-methods are based either on standardized stereotactic coordinates translated to the individual patient or on brain landmarks requiring neuroanatomical skills for their identification. We developed a script automating the inclusion of already validated targets into patients' MRI, and also a new method to target DLPFC based on neuroanatomical landmarks. The present study aims to assess this new approach.
  
  
  METHODS
  Four targets were compared on 40 hemispheres: three previously validated methods (2 using superimposition of standardized targets on patient MRI and 1 using neuroanatomical landmarks) and the new one presented here. Resulting targets were presented in the individual space and in stereotactic spaces (MNI and Talairach) with the main objective being to reach the middle frontal gyrus and BA9/46. Target dispersion and distances between targets were assessed.
  
  
  RESULTS
  All targets were located in the middle frontal gyrus. Our proposed neuro-anatomical target was equivalent to or even better than the previously existing one if we consider the criteria of BA46 achievement and dispersion.
  
  
  CONCLUSIONS
  The proposed neuroanatomical method and automation of the stereotactic method allow simple and reliable targeting of DLPFC for rTMS treatment.
authors.affiliation: Service de neurochirurgie, hôpital Nord, 42055 Saint-Étienne cedex 2, France; Inserm U1028, Central Integration of Pain Unit, Lyon Neuroscience Research Center, 69000 Lyon, France; Intégration centrale de la douleur, université Jean-Monnet, 42023 Saint-Étienne, France. Electronic address: benjamin.pommier@neurochirurgie.fr.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Pommier
authors.affiliation: Service de neurochirurgie, hôpital Nord, 42055 Saint-Étienne cedex 2, France; Inserm U1028, Central Integration of Pain Unit, Lyon Neuroscience Research Center, 69000 Lyon, France; Intégration centrale de la douleur, université Jean-Monnet, 42023 Saint-Étienne, France.
authors.forename: François
authors.initials: F
authors.lastname: Vassal
authors.affiliation: Service de radiologie centrale, hôpital Nord, 42055 Saint-Etienne cedex 2, France.
authors.forename: Claire
authors.initials: C
authors.lastname: Boutet
authors.affiliation: Service de neurologie, hôpital Nord, 42055 Saint-Etienne cedex 2, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Jeannin
authors.affiliation: Inserm U1028, Central Integration of Pain Unit, Lyon Neuroscience Research Center, 69000 Lyon, France; Intégration centrale de la douleur, université Jean-Monnet, 42023 Saint-Étienne, France; Service de neurologie, hôpital Nord, 42055 Saint-Etienne cedex 2, France.
authors.forename: Roland
authors.initials: R
authors.lastname: Peyron
authors.affiliation: Inserm U1028, Central Integration of Pain Unit, Lyon Neuroscience Research Center, 69000 Lyon, France; Intégration centrale de la douleur, université Jean-Monnet, 42023 Saint-Étienne, France; Service de neurologie, hôpital Nord, 42055 Saint-Etienne cedex 2, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Faillenot
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D038361:Neuronavigation / Q000379:methods*; D017397:Prefrontal Cortex / Q000503:physiopathology*; D012984:Software; D050781:Transcranial Magnetic Stimulation / Q000379:methods*
keywords: CPFDL; Cortex préfrontal; DLPFC; Depression; Dépression; Neuronavigation; Prefrontal Cortex; rTMS