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Journal of Neurosurgical Sciences 2003 March;47(1):26-32

lingua: Inglese

MRI indirect stereotactic targeting for deep brain stimulation in Parkinson’s disease

Landi A. 1, Grimaldi M. 2, Antonini A. 4, Parolin M. 1, Zincone A. 3, Marina R. 2, De Grandi C. 2, Sganzerla E. P. 1, Gaini S. M. 1

1 Department of Neurosurgery University of Milano-Bicocca S. Gerardo Hospital, Monza (MI), Italy
2 Department of Neuroradiology University of Milano-Bicocca S. Gerardo Hospital, Monza (MI), Italy
3 Department of Neurology University of Milano-Bicocca S. Gerardo Hospital, Monza (MI), Italy
4 Parkinson’s Center CTO-ICP, Milan, Italy


Aim. Stereotactic local­isa­tion of ­brain tar­gets for func­tion­al neu­ro­sur­gery ­might be ­obtained ­with dif­fer­ent neu­ro­im­ag­ing sourc­es. Magnetic res­o­nance (MR) ­might be of par­tic­u­lar inter­est for its ­high def­i­ni­tion of the var­i­ous ­brain struc­tures; unfor­tu­nate­ly, mag­net­ic ­field dis­tor­tion and inac­cu­ra­cy in imag­ing repro­duc­tion con­strain the use of MRI in ster­eo­tac­tic sur­gery.
Methods. We ­present an experi­men­tal ­work devot­ed to the util­iza­tion of MRI in the tar­get­ing of the sub­tha­lam­ic nucle­us for ­deep ­brain stim­u­la­tion (DBS) in Par­kin­so­nian ­patients.
Results. Experimental ­data ­were ­obtained ­after PVC phan­tom and ­fixed ­human ­brain meas­ure­ments of the ster­eo­tac­tic coor­di­nates of spe­cif­ic ­basal gan­glia struc­tures. Intrinsic and exter­nal sourc­es of ­error and imag­ing dis­tor­tion ­have ­been care­ful­ly cor­rect­ed. Afterwards, 36 ­patients, oper­at­ed for DBS in the sub­thal­a­mus for Parkinson’s disease (PD), ­have ­been inves­ti­gat­ed. MRI tar­get­ing ­proved to be clin­i­cal­ly suc­cess­ful; com­par­ing ana­tom­i­cal and neu­ro­phys­io­log­i­cal find­ings, MRI tar­get­ing scat­tered ­from the neu­ro­phys­io­log­i­cal tar­get­ing in a minor­ity of cas­es.
Conclusion. MRI tar­get­ing ­proved to be reli­able for func­tion­al ster­eo­tac­tic sur­gery, pend­ing care­ful and ade­quate qual­ity con­trol of the dis­tor­tion and of the sourc­es of ­error.

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