Abstract
Deep brain stimulation (DBS) of the subthalamic nucleus is a neurosurgical intervention for Parkinson’s disease patients who no longer appropriately respond to drug treatments. A small fraction of patients will fail to respond to DBS, develop psychiatric and cognitive side-effects, or incur surgery-related complications such as infections and hemorrhagic events. In these cases, DBS may require recalibration, reimplantation, or removal. These negative responses to treatment can partly be attributed to suboptimal pre-operative planning procedures via direct targeting through low-field and low-resolution magnetic resonance imaging (MRI). One solution for increasing the success and efficacy of DBS is to optimize preoperative planning procedures via sophisticated neuroimaging techniques such as high-resolution MRI and higher field strengths to improve visualization of DBS targets and vasculature. We discuss targeting approaches, MRI acquisition, parameters, and post-acquisition analyses. Additionally, we highlight a number of approaches including the use of ultra-high field (UHF) MRI to overcome limitations of standard settings. There is a trade-off between spatial resolution, motion artifacts, and acquisition time, which could potentially be dissolved through the use of UHF-MRI. Image registration, correction, and post-processing techniques may require combined expertise of traditional radiologists, clinicians, and fundamental researchers. The optimization of pre-operative planning with MRI can therefore be best achieved through direct collaboration between researchers and clinicians.
Highlights
Longevity is increasing and triggering a surge in age-related, multimorbid neurodegenerative diseases [1,2]
We have discussed some of the differences in current clinical magnetic resonance imaging (MRI) practices with optimized and ultra-high field (UHF)-MRI methods commonly employed in research environments
The limitations incurred regarding reduced signal in clinical MRI and increased acquisition time with optimized 3 T can be largely overcome with the use of UHF-MRI
Summary
Longevity is increasing and triggering a surge in age-related, multimorbid neurodegenerative diseases [1,2]. As the disease progresses, initially beneficial drug treatments become less effective in about 40% of patients At this stage, the therapeutic window begins to narrow and the medication may wear off faster, resulting in the re-emergence or worsening of motor fluctuations [7,8]. In PD, dopaminergic degradation of the substantia nigra (SN) is thought to result in inhibition of direct pathways, as well as disinhibition of indirect and hyper-direct pathways This leads to the functional disinhibition of output to motor-related areas of the cortex, which is thought to produce impaired movement and reduced movement control [16]. These side effects and adverse outcomes can partially be attributed to suboptimal placement of the DBS lead, which is dependent on the accuracy of the preoperative planning procedures [30,31]
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