Personalized mapping of the deep brain with a white matter attenuated inversion recovery (WAIR) sequence at 1.5-tesla: Experience based on a series of 156 patients

• Published in: Neuro-chirurgie Vol. 62; no. 4; pp. 183 - 189
• Main Authors: Zerroug, A, Gabrillargues, J, Coll, G, Vassal, F, Jean, B, Chabert, E, Claise, B, Khalil, T, Sakka, L, Feschet, F, Durif, F, Boyer, L, Coste, J, Lemaire, J.-J
• Format: Journal Article
• Language: English
• Published: France Elsevier Masson SAS 01.08.2016; Elsevier Masson
• Subjects: Anatomy; Bioengineering; Brain Mapping; DBS; Deep brain; Deep Brain Stimulation - methods; Direct targeting; Electrodes, Implanted; Female; Globus Pallidus - surgery; Human health and pathology; Humans; Imaging; Imaging, Three-Dimensional - methods; Life Sciences; Magnetic Resonance Imaging - methods; Male; Mapping; MRI; Neurobiology; Neurons and Cognition; Neurosurgery; Stereotaxic Techniques; Surgery; White Matter - physiopathology; Direct targeting; Mapping; DBS; Anatomy; MRI; Deep brain
• ISSN: 0028-3770; 1773-0619
• DOI: 10.1016/j.neuchi.2016.01.009

Abstract Objective Deep brain mapping has been proposed for direct targeting in stereotactic functional surgery, aiming to personalize electrode implantation according to individual MRI anatomy without atlas or statistical template. We report our clinical experience of direct targeting in a series of 156 patients operated on using a dedicated Inversion Recovery Turbo Spin Echo sequence at 1.5-tesla, called White Matter Attenuated Inversion Recovery (WAIR). Methods After manual contouring of all pertinent structures and 3D planning of trajectories, 312 DBS electrodes were implanted. Detailed anatomy of close neighbouring structures, whether gray nuclei or white matter regions, was identified during each planning procedure. We gathered the experience of these 312 deep brain mappings and elaborated consistent procedures of anatomical MRI mapping for pallidal, subthalamic and ventral thalamic regions. We studied the number of times the central track anatomically optimized was selected for implantation of definitive electrodes. Results WAIR sequence provided high-quality images of most common functional targets, successfully used for pure direct stereotactic targeting: the central track corresponding to the optimized primary anatomical trajectory was chosen for implantation of definitive electrodes in 90.38%. Conclusion WAIR sequence is anatomically reliable, enabling precise deep brain mapping and direct stereotactic targeting under routine clinical conditions.