Journal: Frontiers in Human Neuroscience
Article Title: MR Tractography-Based Targeting and Physiological Identification of the Cuneiform Nucleus for Directional DBS in a Parkinson’s Disease Patient With Levodopa-Resistant Freezing of Gait
doi: 10.3389/fnhum.2021.676755
Figure Lengend Snippet: MR tractography-based targeting of the cuneiform nucleus. Posterior oblique (A) and sagittal (B) views of a three-dimensional reconstruction of the regional anatomy and tractography based on available template atlases in Lead DBS ( ; ; ). A model of the Boston Scientific Vercise Cartesia TM directional electrode is placed in the field targeting the cuneiform nucleus bilaterally for demonstration. CnF, cuneiform nucleus; CTT, central tegmental tract; GPi, globus pallidus internus; ML, medial lemniscus; PPN, pedunculopontine nucleus; RN, red nucleus; SCP, superior cerebellar peduncle tracts; SN, substantia nigra; STN, subthalamic nucleus; STT, spinothalamic tract. (C–G) Subject specific tractography-based targeting, visualized in Brainlab Elements software (Brainlab AG, Munich, Germany). (C) Frontal view from above of subject’s left medial lemniscus reconstruction (fuchsia) in relation to a preplanned estimate of the CnF target (blue) against a pons level axial slice of the brain. (D) Posterior view of the final electrode positions in relation to the estimated CnF target (red) and the subject’s reconstructed central tegmental tracts (light blue). (E) Frontal and (F,G) sagittal views of the final electrode positions in relation to the thalamus, substantia nigra (SN), subthalamic nuclei (STN), and CnF (red).
Article Snippet: Based on our intraoperative physiology, an octopolar directional DBS electrode (Vercise Cartesia TM , Boston Scientific) was implanted to center the directional electrodes at the region that best elicited leg EMG oscillations.
Techniques: Software