1 Joint Department of Medical Imaging, University of Toronto, Toronto, ON, Canada.
2 University Health Network, Toronto, ON, Canada.
3 Department of Psychology, Concordia University, Montreal, Quebec, Canada.
4 Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.
5 Division of Neurology, Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN University of Toronto, Toronto, Ontario, Canada.
6 Functional Neurosurgery Unit, Department of Clinical and Movement Neurosciences, University College London, Queen Square Institute of Neurology, London, UK.
7 University Health Network, Toronto, ON, UK. alfonso.fasano@uhn.ca.
8 Krembil Brain Institute, Movement Disorders Centre - Toronto Western Hospital, 399 Bathurst St, 7McL410, Toronto, ON, M5T 2S8, Canada. alfonso.fasano@uhn.ca.
9 Center for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, ON, Canada. alfonso.fasano@uhn.ca.

Neuroimaging Technological Advancements for Targeting in Functional Neurosurgery.

Curr Neurol Neurosci Rep. 2019 May 30;19(7):42

Authors: Boutet A, Gramer R, Steele CJ, Elias GJB, Germann J, Maciel R, Kucharczyk W, Zrinzo L, Lozano AM, Fasano A

Abstract

PURPOSE OF REVIEW: Ablations and particularly deep brain stimulation (DBS) of a variety of CNS targets are established therapeutic tools for movement disorders. Accurate targeting of the intended structure is crucial for optimal clinical outcomes. However, most targets used in functional neurosurgery are sub-optimally visualized on routine MRI. This article reviews recent neuroimaging advancements for targeting in movement disorders.

RECENT FINDINGS: Dedicated MRI sequences can often visualize to some degree anatomical structures commonly targeted during DBS surgery, including at 1.5-T field strengths. Due to recent technological advancements, MR images using ultra-high magnetic field strengths and new acquisition parameters allow for markedly improved visualization of common movement disorder targets. In addition, novel neuroimaging techniques have enabled group-level analysis of DBS patients and delineation of areas associated with clinical benefits. These areas might diverge from the conventionally targeted nuclei and may instead correspond to white matter tracts or hubs of functional networks. Neuroimaging advancements have enabled improved direct visualization-based targeting as well as optimization and adjustment of conventionally targeted structures.

PMID: 31144155 [PubMed - in process]