Open AccessVolumetric Image Guidance for Motor Cortex Stimulation: Integration of Three-dimensional Cortical Anatomy and Functional Imaging
Author(s) -
Alireza Gharabaghi,
Dieter Hellwig,
Steffen K. Rosahl,
Ramin Shahidi,
Christoph Schrader,
HansJoachim Freund,
Madjid Samii
Publication year - 2005
Publication title -
operative neurosurgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.791
H-Index - 21
eISSN - 2332-4260
pISSN - 2332-4252
DOI - 10.1227/01.neu.0000164385.42652.9e
Subject(s) - medicine , neuronavigation , functional magnetic resonance imaging , magnetic resonance imaging , stimulation , motor cortex , functional electrical stimulation , neuroscience , deep brain stimulation , functional imaging , biomedical engineering , electrode array , radiology , electrode , psychology , pathology , disease , parkinson's disease , chemistry
OBJECTIVE: Epidural electrical stimulation of the motor cortex is a promising treatment option in patients with intractable pain. Varying rates of success in long-term pain relief have been attributed to inaccurate positioning of the electrode array, partly because the sulcal landmarks are not directly visualized. We describe an integrated protocol for precise electrode placement, combining functional image guidance and intraoperative electrical stimulation in the awake patient. METHODS: Volumetric rendering of a three-dimensional (3-D) magnetic resonance data set was used to visualize the cortical surface and to superimpose functional magnetic resonance imaging data in six patients with refractory chronic pain. The intraoperative positioning of the quadripolar electrode array was monitored by functional 3-D image guidance. Continuous electrophysiological monitoring and clinical assessment of the motor effects complemented the procedure. RESULTS: Volumetrically rendered 3-D images were advantageous for the location of the burr hole over the perirolandic area by revealing individual cortical morphological features (e.g., the hand knob) and function at the same time. The exact position of the electrodes was verified reliably by cortical stimulation. No complications were observed throughout the procedures. CONCLUSION: The combination of 3-D functional neuronavigation, intraoperative electrical stimulation, and continuous motor output monitoring in awake patients provides optimal information for the identification of the appropriate somatotopic area of motor cortex. This combined imaging and stimulation approach for electrode positioning offers a safe and minimal invasive strategy for the treatment of intractable chronic pain in selected patients.