Simulation and assessment of cerebrovascular damage in deep brain stimulation using a stereotactic atlas of vasculature and structure derived from multiple 3-and 7-tesla scans
Simulation and assessment of cerebrovascular damage in deep brain stimulation using a stereotactic atlas of vasculature and structure derived from multiple 3-and 7-tesla scans
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DOI：
10.3171/2010.2.jns091528
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发表时间：
2010-12-01
影响因子：
4.1
通讯作者：
Knopp, Michael V.
中科院分区：
文献类型：
--
作者：
Nowinski, Wieslaw L.;Chua, Beng Choon;Knopp, Michael V.
目的。深部脑刺激（DBS）最严重的并发症是颅内出血。对脑血管系统的详细了解可以降低这种疾病的发生率。通常在立体定向和功能神经外科 (SFN) 中使用 1.5-T（有时甚至是 3-T）成像装置获得的形态学扫描很难描绘脉管系统。先进的血管造影成像，包括 3-T 和 7-T 3D 飞行时间和磁敏感加权成像以及 320 层 CT 血管造影，可以非常详细地描绘血管。然而，这些采集数据并未用于 SFN 临床实践，并且尚无可靠的处理方法。因此，作者提出使用详细的 3D 立体定向脑血管图谱来协助 SFN 规划并可能减少 DBS 诱发的出血。方法。通过多次 3-T 和 7-T 扫描构建了非常详细的动脉、静脉和硬脑膜窦的 3D 脑血管图谱。该图谱包含超过 900 个容器，每个容器都标有名称和直径，最小的直径为 90 微米。皮质区域、脑室系统和皮质下结构被完全分割和标记，包括主要的立体定向目标结构：丘脑底核、丘脑腹侧中间核和苍白球内部。作者还开发了一种带有嵌入式图集的计算机模拟器，该模拟器能够通过最大限度地减少 DBS 电极对脑血管系统和重要大脑结构的穿透来计算有效的电极轨迹。该模拟器为神经外科医生提供了图谱操作、目标选择、轨迹规划和编辑、3D显示和操作、电极脑穿透计算等功能。该模拟表明，插入额中回的DBS电极可以与多条动脉和静脉相交，包括1）大脑前动脉的前内侧额动脉以及大脑中动脉的前额动脉和中央沟动脉（直径范围0.4-0.6毫米）； 2) 前额静脉、尾状前静脉和髓静脉（直径范围 0.1-2.3 毫米）。这项工作还表明，场强和脉冲序列对船舶描绘有重大影响。 1.5-T、3-T 和 7-T 扫描的 3D 血管段数量分别为 215、363 和 907。结论。在微记录和刺激过程中将设备插入大脑可能会导致标准扫描无法辨别的微出血。 DBS 电极位置的微小变化可能会导致患者发生重大变化。所描述的模拟提高了神经外科医生对这种现象的认识。该模拟器使神经外科医生能够分析轨道与脑血管系统、心室、皮质下结构和皮质区域之间的空间关系，从而可以更有效地放置 DBS 电极，从而有可能减少对患者的刺激过程的侵入性。 （DOI：10.3171/2010.2.JNS091528）
Object. The most severe complication of deep brain stimulation (DBS) is intracranial hemorrhage. Detailed knowledge of the cerebrovasculature could reduce the rate of this disorder. Morphological scans typically acquired in stereotactic and functional neurosurgery (SFN) by using 1.5-T (or sometimes even 3-T) imaging units poorly depict the vasculature. Advanced angiographic imaging, including 3- and 7-T 3D time-of-flight and susceptibility weighted imaging as well as 320-slice CT angiography, depict the vessels in great detail. However, these acquisitions are not used in SFN clinical practice, and robust methods for their processing are not available yet. Therefore, the authors proposed the use of a detailed 3D stereotactic cerebrovascular atlas to assist in SFN planning and to potentially reduce DBS-induced hemorrhage.Methods. A very detailed 3D cerebrovascular atlas of arteries, veins, and dural sinuses was constructed from multiple 3- and 7-T scans. The atlas contained > 900 vessels, each labeled with a name and diameter with the smallest having a 90-mu m diameter. The cortical areas, ventricular system, and subcortical structures were fully segmented and labeled, including the main stereotactic target structures: subthalamic nucleus, ventral intermediate nucleus of the thalamus, and internal globus pallidus. The authors also developed a computer simulator with the embedded atlas that was able to compute the effective electrode trajectory by minimizing penetration of the cerebrovascular system and vital brain structures by a DBS electrode. The simulator provides the neurosurgeon with functions for atlas manipulation, target selection, trajectory planning and editing, 3D display and manipulation, and electrode-brain penetration calculation.Results. This simulation demonstrated that a DBS electrode inserted in the middle frontal gyrus may intersect several arteries and veins including 1) the anteromedial frontal artery of the anterior cerebral artery as well as the prefrontal artery and the precentral sulcus artery of the middle cerebral artery (range of diameters 0.4-0.6 mm); and 2) the prefrontal, anterior caudate, and medullary veins (range of diameters 0.1-2.3 mm). This work also shows that field strength and pulse sequence have a substantial impact on vessel depiction. The numbers of 3D vascular segments are 215, 363, and 907 for 1.5-, 3-, and 7-T scans, respectively.Conclusions. Inserting devices into the brain during microrecording and stimulation may cause microbleeds not discernible on standard scans. A small change in the location of the DBS electrode can result in a major change for the patient. The described simulation increases the neurosurgeon's awareness of this phenomenon. The simulator enables the neurosurgeon to analyze the spatial relationships between the track and the cerebrovasculature, ventricles, subcortical structures, and cortical areas, which allows the DBS electrode to be placed more effectively, and thus potentially reducing the invasiveness of the stimulation procedure for the patient. (DOI: 10.3171/2010.2.JNS091528)