Does Navigated Transcranial Stimulation Increase the Accuracy of Tractography? A Prospective Clinical Trial Based on Intraoperative Motor Evoked Potential Monitoring During Deep Brain Stimulation
Does Navigated Transcranial Stimulation Increase the Accuracy of Tractography? A Prospective Clinical Trial Based on Intraoperative Motor Evoked Potential Monitoring During Deep Brain Stimulation
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DOI：
10.1227/neu.0000000000000715
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发表时间：
2015-06-01
期刊：
影响因子：
4.8
通讯作者：
Weise, Lutz Martin
中科院分区：
文献类型：
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作者：
Forster, Marie-Therese;Hoecker, Alexander Claudius;Weise, Lutz Martin
背景：基于弥散张量成像的神经束造影已成为神经外科手术中描绘白质束的流行工具。目的：探讨导航经颅磁刺激（nTMS）是否能提高纤维追踪的准确性。方法：根据运动皮质的解剖描绘（n = 14）和nTMS结果（n = 9）进行神经束造影。植入最终电极后，通过电极进行刺激，定义一个刺激阈值，以激发在深部脑刺激手术中记录的运动诱发电位。另一些研究表明，手臂和腿部肌肉也是如此。这一阈值与活性电极接触和两条纤维轨迹之间的最短距离有关。结果通过与深部脑刺激期间运动诱发电位监测的相关性进行评估，深部脑刺激是一种几乎不引起任何脑转移的外科手术。结果：到纤维轨道的距离与运动诱发电位阈值明显相关。基于nTMS的轨迹比基于解剖运动皮层定义的轨迹具有更高的预测价值（P < 001和P = 0.005）。然而，靶位、半球和活性电极接触不影响这种相关性。结论：应用神经束造影技术可提高纤维追踪的准确性。此外，这种方法的组合有可能成为指导电极植入的补充工具。
BACKGROUND: Tractography based on diffusion tensor imaging has become a popular tool for delineating white matter tracts for neurosurgical procedures.OBJECTIVE: To explore whether navigated transcranial magnetic stimulation (nTMS) might increase the accuracy of fiber tracking.METHODS: Tractography was performed according to both anatomic delineation of the motor cortex (n = 14) and nTMS results (n = 9). After implantation of the definitive electrode, stimulation via the electrode was performed, defining a stimulation threshold for eliciting motor evoked potentials recorded during deep brain stimulation surgery. Others have shown that of arm and leg muscles. This threshold was correlated with the shortest distance between the active electrode contact and both fiber tracks. Results were evaluated by correlation to motor evoked potential monitoring during deep brain stimulation, a surgical procedure causing hardly any brain shift.RESULTS: Distances to fiber tracks clearly correlated with motor evoked potential thresholds. Tracks based on nTMS had a higher predictive value than tracks based on anatomic motor cortex definition (P < 001 and P = .005, respectively). However, target site, hemisphere, and active electrode contact did not influence this correlation.CONCLUSION: The implementation of tractography based on nTMS increases the accuracy of fiber tracking. Moreover, this combination of methods has the potential to become a supplemental tool for guiding electrode implantation.