© Georg Thieme Verlag KG Stuttgart · New York
The Safest Electrode Trajectory for Deep Brain Stimulation of the Human Nucleus Accumbens: a Stereotactic Anatomic Study
19 April 2011 (online)
Background: The primary purpose of our stereotactic anatomic study was to determine the safest electrode trajectory for deep brain stimulation (DBS) of the human nucleus accumbens (NA). Considering NA DBS together with the complications related to surgical implantation and based on methods for assessing the electrode trajectory we tried to reveal the secret of a trajectory for targeting the NA with the highest possible level of safety.
Material and Methods: Our material consisted of 30 cerebral hemispheres we have in our Department from cadaver donors for students' education. We identified the electrode's target point in coronal sections. As safe we considered a trajectory from the cerebral cortex to the NA, which traverses the anterior limb of the internal capsule (AIC) without passing through either the caudate nucleus or putamen. We measured the minimum, maximum and safest coronal angles of the electrode trajectory (between the trajectory and the midline), as well as the AIC angle and width of the trajectory angle. We also measured trajectory projection length from the cerebral surface to the superior (d1) and inferior (d2) margins of the NA.
Results: The safest trajectory angle for NA DBS was found to have a mean value of 29.10 degrees, ranging from 23.80 to 35.40 degrees. The mean AIC angle was 33.78 degrees. We found no statistically significant difference between right and left hemispheres and a strong statistical relation between the safest electrode trajectory and AIC angle. Mean values of d1 and d2 were found to be 53.57 mm and 60.86 mm respectively. The mean value of the length of the electrode trajectory in coronal projection within the NA (d2–d1) was found to be 7.29 mm.
Conclusion: The new knowledge that our stereotactic anatomic study offers is a definition of the safest electrode trajectory for NA DBS, its coronal angle width, as well as an estimation of its length.
anterior limb of the internal capsule - deep brain stimulation - electrode trajectory - nucleus accumbens
- 1 Neto LL, Oliveira E, Correia F. et al . The human nucleus accumbens: Where is it? A stereotactic, anatomical and magnetic resonance imaging study. Neuromodul: Technol neural interface. 2008; 11 13-22
- 2 Halpern CH, Wolf JA, Bale TL. et al . Deep brain stimulation in the treatment of obesity. J Neurosurg. 2008; 109 625-634
- 3 Kuhn J, Lenartz D, Huff W. et al . Transient manic-like episode following bilateral deep brain stimulation of the nucleus accumbens and the internal capsule in a patient with Tourette syndrome. Neuromodul: Technol neural interface. 2008; 11 128-131
- 4 Schlaepfer TE, Cohen MX, Frick C. et al . Deep brain stimulation to reward circuitry alleviates anhedonia in refractory major depression. Neuropsychopharmacol. 2008; 33 368-377
- 5 Juckel G, Uhl I, Padberg F. et al . Psychosurgery and deep brain stimulation as ultima ratio treatment for refractory depression. Eur Arch Psychiatry Clin Neurosci. 2009; 259 1-7
- 6 Sturm V, Lenartz D, Koulousakis A. et al . The nucleus accumbens: a target for deep brain stimulation in obsessive-compulsive and anxiety disorders. J Chem Neuroanat. 2003; 26 293-299
- 7 Martin AJ, Larson PS, Ostrem JL. et al . Interventional magnetic resonance guidance of deep brain stimulator implantation for Parkinson disease. Top Magn Reson Imaging. 2008; 19 213-221
- 8 Fiegele T, Feuchtner G, Sohm F. et al . Accuracy of stereotactic electrode placement in deep brain stimulation by intraoperative computed tomography. Parkinsonism Relat Disord. 2008; 14 595-599
- 9 Abelson JL, Curtis GC, Sagher O. et al . Deep brain stimulation for refractory obsessive-compulsive disorder. Biol Psychiatry. 2005; 57 510-516
- 10 Greenberg BD, Malone DA, Friehs GM. et al . Three-year outcomes in deep brain stimulation for highly resistant obsessive-compulsive disorder. Neuropsychopharmacol. 2006; 31 2384-2393
- 11 Kuhn J, Lenartz D, Mai JK. et al . Deep brain stimulation of the nucleus accumbens and the internal capsule in therapeutically refractory Tourette-syndrome. J Neurol. 2007; 254 963-965
- 12 Flaherty AW, Williams ZM, Amirnovin R. et al . Deep brain stimulation of the anterior internal capsule for the treatment of Tourette syndrome: technical case report. Neurosurgery. 2005; 57 (ONS Suppl 3) ONS-403
- 13 Hemm S, Coste J, Gabrillargues J. et al . Contact position analysis of deep brain stimulation electrodes on post-operative CT images. Acta Neurochir. 2009; 151 823-829
- 14 Machado A, Rezai AR, Kopell BH. et al . Deep brain stimulation for Parkinson's disease: Surgical technique and perioperative management. Mov Disord. 2006; 21 (Suppl. 14) S247-S258
- 15 Brabec J, Krásený J, Petrovický P. Volumetry of striatum and pallidum in man-anatomy, cytoarchitecture, connections, MRI and aging. Sb Lek. 2003; 104 13-65
Mikras Assias straße 75
Phone: +30/21/0746 2404
Fax: +30/21/0746 2398