J Neurol Surg A Cent Eur Neurosurg 2021; 82(06): 518-525
DOI: 10.1055/s-0040-1715826
Original Article

The Accuracy of Direct Targeting Using Fusion of MR and CT Imaging for Deep Brain Stimulation of the Subthalamic Nucleus in Patients with Parkinson's Disease

Fadi Almahariq
1   Department of Neurosurgery, Clinical Hospital Dubrava, Zagreb, Croatia
2   Center of Excellence in Basic, Clinical and Translational Neuroscience, Zagreb, Croatia
Goran Sedmak
2   Center of Excellence in Basic, Clinical and Translational Neuroscience, Zagreb, Croatia
3   Croatian Institute for Brain Research, School of Medicine, University of Zagreb, Zagreb, Croatia
Vladimira Vuletić
4   Department of Neurology, School of Medicine, University of Rijeka, University Hospital Rijeka, Rijeka, Croatia
Domagoj Dlaka
1   Department of Neurosurgery, Clinical Hospital Dubrava, Zagreb, Croatia
Darko Orešković
1   Department of Neurosurgery, Clinical Hospital Dubrava, Zagreb, Croatia
Petar Marčinković
1   Department of Neurosurgery, Clinical Hospital Dubrava, Zagreb, Croatia
1   Department of Neurosurgery, Clinical Hospital Dubrava, Zagreb, Croatia
Darko Chudy
1   Department of Neurosurgery, Clinical Hospital Dubrava, Zagreb, Croatia
2   Center of Excellence in Basic, Clinical and Translational Neuroscience, Zagreb, Croatia
5   Department of Surgery, School of Medicine, University of Zagreb, Zagreb, Croatia
› Author Affiliations


Introduction In 33 consecutive patients with Parkinson's disease (PD) undergoing awake deep brain stimulation (DBS) without microelectrode recording (MER), we assessed and validated the precision and accuracy of direct targeting of the subthalamic nucleus (STN) using preoperative magnetic resonance imaging (MRI) and stereotactic computed tomography (CT) image fusion combined with immediate postoperative stereotactic CT and postoperative MRI, and we report on the side effects and clinical results up to 6 months' follow-up.

Materials and Methods Preoperative nonstereotactic MRI and stereotactic CT images were merged and used for planning the trajectory and final lead position. Immediate postoperative stereotactic CT and postoperative nonstereotactic MRI provided the validation of the final electrode position. Changes in the Unified Parkinson's Disease Rating Scale III (UPDRS III) scores and the levodopa equivalent daily doses (LEDD) and appearance of adverse side effects were assessed.

Results The mean Euclidian distance (ED) error between the planned position and the final position of the lead in the left STN was 1.69 ± 0.82 mm and that in the right STN was 2.12 ± 1.00. The individual differences between planned and final position in each of the three coordinates were less than 2 mm. The UPDRS III scores improved by 75% and LEDD decreased by 45%. Few patients experienced complications, such as postoperative infection (n = 1), or unwanted side effects, such as emotional instability (n = 1).

Conclusion Our results confirm that direct targeting of an STN on stereotactic CT merged with MRI could be a valid method for placement the DBS electrode. The magnitude of our targeting error is comparable with the reported errors when using MER and other direct targeting approaches.

Financial Disclosures

This research was supported by Croatian Science Foundation grant no. UIP-2017–05–7578 (G.S.). This publication was cofinanced by the European Union through the European Regional Development Fund, Operational Program Competitiveness and Cohesion, grant agreement no. KK., CoRE - Neuro.

Supplementary Material

Publication History

Received: 26 July 2019

Accepted: 13 February 2020

Article published online:
22 February 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
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