Comparison of atlas- and magnetic resonance imaging-based stereotactic targeting of the globus pallidus internus in the performance of deep brain stimulation for treatment of dystonia.

OBJECT To assess the validity of relying on atlases during stereotactic neurosurgery, the authors compared target coordinates in the globus pallidus internus (GPi) obtained using magnetic resonance (MR) imaging with those determined using an atlas. The targets were used in deep brain stimulation (DBS) for the treatment of generalized dystonia. METHODS Thirty-five patients, who were treated using bilateral DBS of the GPi, were included in this study. The target was selected on three-dimensional MR images by direct visual recognition of the GPi. The coordinates were automatically recorded using dedicated software. They were translated into the anterior commissure-posterior commissure (AC-PC) coordinate system by using a matrix transformation process. The same GPi target was defined, based on the locations of brain structures shown in the atlases of Schaltenbrand and Talairach. Magnetic resonance imaging-based GPi target coordinates were statistically compared with the corresponding atlas-based coordinates by applying the Student t-test. A significant difference (p < 0.001) was demonstrated in x, y, and z directions between MR imaging-based and Schaltenbrand atlas-derived target coordinates. The comparison with normalized Talairach atlas coordinates demonstrated a significant difference (p < 0.01) in the y and z directions, although not in the x direction (p = 0.12). No significant correlation existed between MR imaging-based target coordinates and patient age (p > 0.1). No significant correlation was observed between MR imaging-based target coordinates and patient sex in the y and z directions (p > 0.9), although it was significant in the x direction (p < 0.05). A significant variation in coordinates and the length of the AC-PC line was revealed only in the y direction (p < 0.005). CONCLUSIONS A significant difference was found between target coordinates obtained by direct visual targeting on MR images (validated by postoperative clinical results) and those obtained by indirect targeting based on atlases.

[1]  T. Autti,et al.  MRI of the normal brain from early childhood to middle age , 1994, Neuroradiology.

[2]  M. Zanca,et al.  Magnetic resonance imaging stereotactic target localization for deep brain stimulation in dystonic children. , 2000, Journal of neurosurgery.

[3]  T. Wichmann,et al.  Electrophysiological localization of the substantia nigra in the parkinsonian nonhuman primate. , 2000, Journal of neurosurgery.

[4]  S. Hemm,et al.  Treatment of DYT1-generalised dystonia by stimulation of the internal globus pallidus , 2000, The Lancet.

[5]  S. Hemm,et al.  Treatment of early-onset dystonia: update and a new perspective , 2000, Child's Nervous System.

[6]  J. Obeso,et al.  Stereotactic targeting of the globus pallidus internus in Parkinson's disease: imaging versus electrophysiological mapping. , 2000, Neurosurgery.

[7]  Jack L. Lancaster,et al.  Accurate High-Speed Spatial Normalization Using an Octree Method , 1999, NeuroImage.

[8]  N. Vayssiere,et al.  [Treatment of early-onset generalized dystonia by chronic bilateral stimulation of the internal globus pallidus. Apropos of a case]. , 1999, Neuro-Chirurgie.

[9]  S Fahn,et al.  Tolcapone , 1998, Neurology.

[10]  C Marsault,et al.  Chronic thalamic stimulation with three-dimensional MR stereotactic guidance. , 1997, AJNR. American journal of neuroradiology.

[11]  C. Davatzikos.  Spatial normalization of 3D brain images using deformable models. , 1996, Journal of computer assisted tomography.

[12]  B. J. Casey,et al.  Quantitative magnetic resonance imaging of human brain development: ages 4-18. , 1996, Cerebral cortex.

[13]  M. Hariz,et al.  Ventroposterolateral pallidotomy can abolish all parkinsonian symptoms. , 1992, Stereotactic and functional neurosurgery.

[14]  M Desgeorges,et al.  MRI and stereotaxis. Choice of an approach route on an independent console. , 1991, Journal of neuroradiology. Journal de neuroradiologie.

[15]  J. Talairach,et al.  Co-Planar Stereotaxic Atlas of the Human Brain: 3-Dimensional Proportional System: An Approach to Cerebral Imaging , 1988 .

[16]  S Fahn,et al.  Concept and classification of dystonia. , 1988, Advances in neurology.

[17]  T. H. Newton,et al.  MRI of normal brain maturation. , 1986, AJNR. American journal of neuroradiology.

[18]  L. Laitinen,et al.  Brain targets in surgery for Parkinson's disease. Results of a survey of neurosurgeons. , 1985, Journal of neurosurgery.

[19]  C. Marsden,et al.  Validity and reliability of a rating scale for the primary torsion dystonias , 1985, Neurology.

[20]  M. Asmussen.  The use of incompletely linked markers in genetic counseling: accuracy versus linkage. , 1985, Human heredity.

[21]  S. Fahn.  The varied clinical expressions of dystonia. , 1984, Neurologic clinics.

[22]  R. Bajcsy,et al.  A computerized system for the elastic matching of deformed radiographic images to idealized atlas images. , 1983, Journal of computer assisted tomography.

[23]  L. Leksell,et al.  TREATMENT OF PARKINSONISM BY STEREOTACTIC THERMOLESIONS IN THE PALLIDAL REGION. A clinical evaluation of 81 cases. , 1960, Acta psychiatrica Scandinavica.