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摘要
Careful trajectory planning on preoperative vascular imaging is an essential step in deep brain stimulation (DBS) to minimize risks of hemorrhagic complications and postoperative neurological deficits. This paper compares 2 MRI methods for visualizing cerebral vasculature and planning DBS probe trajectories: a single data set Ti-weighted scan with double-dose gadolinium contrast (Tlw-Gd) and a multi data set protocol consisting of a Ti-weighted structural, susceptibility-weighted venography, and time-of-flight angiography (T1w-SWI-TOF). Two neurosurgeons who specialize in neuromodulation surgery planned bilateral STN DBS in 18 patients with Parkinson%26apos;s disease (36 hemispheres) using each protocol separately. Planned trajectories were then evaluated across all vascular data sets (Tlw-Gd, SWI, and TOF) to detect possible intersection with blood vessels along the entire path via an objective vesselness measure. The authors%26apos; results show that trajectories planned on Tlw-SWI-TOF successfully avoided the cerebral vasculature imaged by conventional T1w-Gd and did not suffer from missing vascular information or imprecise data set registration. Furthermore, with appropriate planning and visualization software, trajectory corridors planned on Tlw-SWI-TOF intersected significantly less fine vasculature that was not detected on the Tlw-Gd (p %26lt; 0.01 within 2 mm and p %26lt; 0.001 within 4 mm of the track centerline). The proposed Tlw-SWI-TOF protocol comes with minimal effects on the imaging and surgical workflow, improves vessel avoidance, and provides a safe costeffective alternative to injection of gadolinium contrast.
- 出版日期2014-7
- 单位McGill
