Stereotactic and Functional Neurosurgery最新文献

{"title":"Functional Outcomes and Quality of Life after Unilateral MRgFUS Subthalamotomy in Parkinson's Disease.","authors":"Marina Campins-Romeu, Rebeca Conde-Sardón, Isabel Sastre-Bataller, Raquel Baviera-Muñoz, Mireya Losada-López, Carlos Morata-Martínez, María J Ibáñez-Juliá, José L León-Guijarro, Julia Pérez-García, Luis Raga-Rodríguez, Andrés M Lozano, Andrés Gutiérrez-Martín, Irene Martínez-Torres","doi":"10.1159/000552000","DOIUrl":"10.1159/000552000","url":null,"abstract":"<p><strong>Introduction: </strong>Parkinson's disease (PD) leads to progressive motor and non-motor deficits that compromise activities of daily living (ADL) and quality of life (QoL). Although bilateral deep brain stimulation (DBS) of the subthalamic nucleus (STN) is highly effective, its invasiveness restricts use in certain patients. Magnetic resonance-guided focused ultrasound (MRgFUS) subthalamotomy offers a less invasive, lesion-based alternative, but evidence regarding its broader functional impact remains limited. The objective was to assess the effects of unilateral MRgFUS subthalamotomy on motor experiences of daily living (MDS-UPDRS II) and QoL (PDQ-39) in patients with PD.</p><p><strong>Methods: </strong>Thirty patients with asymmetric PD refractory to optimized dopaminergic therapy underwent unilateral MRgFUS subthalamotomy targeting the dorsolateral STN between June 2021 and June 2024. Evaluations were performed at baseline, 6 months, and 12 months using MDS-UPDRS II-III, PDQ-39, EQ-5D, and Berg Balance Scale. Primary endpoints were changes in MDS-UPDRS II and QoL; secondary outcomes included motor function (MDS UPDRS III), Levodopa Equivalent Daily Dose (LEDD), and safety.</p><p><strong>Results: </strong>Off- and on-state MDS-UPDRS II improved by 38.5% and 45.8% at 6 months (p < 0.01) and by 50% in both states at 12 months (p < 0.01). PDQ-39 ADL subdomain improved by 10.4% at 12 months (p = 0.033), while global QoL indices remained stable. Off-state motor scores improved by 35.9% (p < 0.001), with reductions in rigidity (50%), bradykinesia (52.9%), and tremor (81.7%). LEDD decreased by 22.1% (p = 0.003). Adverse events were mild and transient, including dysarthria, facial asymmetry, and gait disturbance.</p><p><strong>Conclusion: </strong>Unilateral MRgFUS subthalamotomy was associated with improvements in motor function and motor-related activities of daily living, with a favorable safety profile. These findings suggest that this approach may represent a potential less invasive therapeutic option for selected patients who are unsuitable for or unwilling to undergo DBS, although results should be interpreted with caution given the study design.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"1-15"},"PeriodicalIF":2.1,"publicationDate":"2026-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148057028","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changes in Gait among Patients with Parkinson's Disease Treated with Deep Brain Stimulation: A Systematic Review and Meta-Analysis.","authors":"Stefania Peñuela-Arango, Lina María Villegas-Trujillo, Lessby Gómez-Salazar, Oscar Andrés Escobar-Vidarte","doi":"10.1159/000551518","DOIUrl":"10.1159/000551518","url":null,"abstract":"<p><strong>Introduction: </strong>Parkinson's disease (PD) significantly impairs gait, particularly in advanced stages. Deep brain stimulation (DBS) has emerged as a therapeutic option for refractory motor symptoms, yet its effects on locomotion remain heterogeneous. The objective was to synthesize the available biomechanical evidence on changes in spatiotemporal gait parameters in PD patients undergoing DBS.</p><p><strong>Methods: </strong>We conducted a systematic review and meta-analysis in accordance with PRISMA 2020. We included original studies with pre- and/or post-DBS gait analyses using instrumented technologies. Methodological quality was assessed with the Cochrane Handbook.</p><p><strong>Results: </strong>Nineteen DBS studies were included. The studies exhibited heterogeneous assessment conditions, encompassing different time points before and after surgery, and both on and off medication and stimulation. The targets analyzed included the subthalamic nucleus, the internal segment of the globus pallidus (GPi), and the pedunculopontine nucleus (PPN). The most frequently reported spatiotemporal parameters were gait speed, step and stride lengths, cadence, and double support time. Data acquisition employed optoelectronic systems, pressure platforms, and inertial sensors.</p><p><strong>Conclusion: </strong>DBS improves spatiotemporal gait parameters in PD, particularly under active stimulation. However, methodological heterogeneity and the limited representation of GPi and PPN constrain generalizability. Instrumented systems enable objective and reproducible assessment, which is key to optimizing functional follow-up and therapeutic decision-making.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"1-20"},"PeriodicalIF":2.1,"publicationDate":"2026-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148056982","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Salvage Gamma Knife Radiosurgery after Prior Non-Radiation Interventions for Trigeminal Neuralgia.","authors":"Venkatesh S Madhugiri, Victor Goulenko, Neil D Almeida, Robert A Fenstermaker, Andrew J Fabiano, Lindsay Lipinski, Dheerendra Prasad","doi":"10.1159/000552680","DOIUrl":"10.1159/000552680","url":null,"abstract":"<p><strong>Introduction: </strong>Salvage Gamma Knife radiosurgery (sGKRS) is increasingly used to treat trigeminal neuralgia (TN) after failed microvascular decompression (MVD) or percutaneous procedures, but predictors of durable pain control are not well defined. We evaluated the outcomes and predictors of pain relief following sGKRS in a single-institution cohort.</p><p><strong>Methods: </strong>We screened all patients treated with GKRS for TN at our institution (1998-2025) and identified 72 patients who had received sGKRS for pain relapse after prior non-radiation interventions. Demographics, treatment plans, radiologic metrics, and pain scores were collated. Response was defined both dichotomously and continuously (change in Roswell Park pain scale/BNI). Multivariate logistic and linear regression were run to identify independent predictors of dichotomous and continuous outcomes.</p><p><strong>Results: </strong>Mean age was 63.3 years; 70.8% were female. Most patients received 80 Gy to the 100% isodose (median ANEZ dose: 11 Gy). sGKRS achieved a 78.1% response rate overall, rising to 81.2% in patients with prior MVD. Strikingly, a lower biologically effective dose (BED) to the trigeminal nerve - specifically BED below 2,000 Gy - was the single independent predictor of response, on multivariate analysis, both overall (p = 0.015) and within the prior-MVD subgroup (p = 0.026). On univariate analysis, higher pretreatment pain severity, V1 involvement, and higher body weight each correlated with better outcomes, though no factor independently predicted the degree of pain improvement on multivariate analysis.</p><p><strong>Conclusions: </strong>sGKRS delivers meaningful pain relief in approximately 78% of patients who have failed other interventions - including those with prior MVD. Counterintuitively, a lower BED to the trigeminal nerve, rather than a higher dose, independently drives response in the salvage setting, suggesting that a neuromodulatory rather than ablative mechanism could be in play. Keeping the BED below 2,000 Gy is the single most impactful modifiable target for treatment planning, and should reframe how salvage radiosurgery prescriptions are designed.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"1-12"},"PeriodicalIF":2.1,"publicationDate":"2026-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148057043","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of Microanatomy-Based Low-Dose Radiosurgery of Vestibular Schwannomas for Hearing Preservation in Patients with Neurofibromatosis Type 2: A Retrospective Analysis of 16 Cases.","authors":"Motohiro Hayashi, Mikhail F Chernov, Ayako Horiba, Mieko Oka, Seiichiro Eguchi, Yuichi Kubota, Takakazu Kawamata","doi":"10.1159/000552251","DOIUrl":"10.1159/000552251","url":null,"abstract":"<p><strong>Introduction: </strong>The role of stereotactic radiosurgery (SRS) of vestibular schwannomas (VS) in patients with neurofibromatosis type 2 (NF2) is still not established well. The objective of this retrospective study was evaluation of effectiveness of proactive microanatomy-based low-dose SRS for serviceable hearing preservation in such cases.</p><p><strong>Methods: </strong>Study cohort included 16 NF2-associated VS in 13 patients, who underwent SRS between January 2002 and March 2022. Median tumor volume was 0.56 cc (range, 0.12-2.75 cc). Hearing on the side of treated tumor corresponded to Gardner-Robertson classes I (12 cases) or II (4 cases). Special emphasis was consistently put on creation of the highly conformal and selective radiosurgical treatment plan based on precise evaluation of the local microanatomy with attempted identification of the nerve of origin and chronological trajectory of growth of the tumor, allowing to estimate the direction and magnitude of the facial nerve and other cranial nerves shift and to prevent them from excessive irradiation. The prescription dose of 12 Gy (15 cases) or 11 Gy (1 case) was delivered at 50% (13 cases) or >50% (3 cases) isodose line. Median maximal cochlear dose was 5.8 Gy (range, 2.2-8.2 Gy).</p><p><strong>Results: </strong>Median posttreatment follow-up was 88 months (range, 30-226 months). Actuarial proportions of cases without hearing deterioration at 3, 5, and 10 years after SRS were, respectively, 0.81 ± 0.10, 0.67 ± 0.12, and 0.56 ± 0.14. Actuarial proportions of cases with serviceable hearing preservation at 3, 5, and 10 years after SRS were, respectively, 0.81 ± 0.10, 0.81 ± 0.10, and 0.67 ± 0.15. Gardner-Robertson class I hearing at the time of treatment and used prescription isodose of 50% showed statistically significant associations with subsequent hearing preservation without deterioration (p = 0.0242 and 0.0024, respectively) and with serviceable hearing preservation (p = 0.0047 and 0.0020, respectively). Specifically, actuarial proportions of cases with serviceable hearing preservation at 5 years after SRS in cases with Gardner-Robertson classes I and II hearing were 1.00 and 0.25 ± 0.22, respectively (p = 0.0009).</p><p><strong>Conclusion: </strong>Gardner-Robertson class I hearing at the time of SRS for VS in patients with NF2 is associated with significantly higher chances of serviceable hearing preservation during subsequent long-term follow-up. It may advocate use of early proactive microanatomy-based low-dose SRS in such cases, particularly in young individuals.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"1-15"},"PeriodicalIF":2.1,"publicationDate":"2026-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147988529","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nonmotor Symptoms in Parkinson's Disease: Neurophysiology Biomarkers and Neuromodulation Approaches.","authors":"Niyati Pathak, Rachel Chen, Astoria Chao, Sarah K Bick","doi":"10.1159/000551492","DOIUrl":"10.1159/000551492","url":null,"abstract":"<p><strong>Background: </strong>Parkinson's disease (PD) is the second most common neurodegenerative disorder, with increasing global incidence and prevalence. While PD is diagnosed based on the presence of classic motor symptoms including tremor, bradykinesia, and rigidity, non-motor symptoms also play an important role in disease pathogenesis. Increasing evidence has demonstrated that non-motor symptoms, including neuropsychiatric changes, cognitive impairment, sleep disturbances, autonomic dysfunction, and pain and sensory symptoms, significantly affect PD patients' disease burden, quality of life, and utilization of healthcare resources.</p><p><strong>Summary: </strong>Deep brain stimulation (DBS) is an effective treatment for motor symptoms in advanced PD. The neurophysiology changes associated with PD motor symptoms are relatively well understood and have been used to inform closed-loop DBS approaches to improve motor symptom control. Unfortunately, effective treatments for many of the non-motor symptoms of advanced PD are lacking, and DBS to treat motor symptoms may worsen non-motor symptoms such as depression, cognitive impairment, and impulsive and compulsive behaviors in some patients.</p><p><strong>Key messages: </strong>Recent work has provided some insight into neurophysiological changes underlying nonmotor symptoms, which may inform development of future therapeutic approaches. In this manuscript, we review neurophysiology biomarkers associated with non-motor symptoms and their application to developing novel neuromodulation treatments. We additionally review how existing DBS approaches may impact non-motor symptoms. We highlight the need for precise and individualized neuromodulation approaches.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"1-14"},"PeriodicalIF":2.1,"publicationDate":"2026-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13193691/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147988992","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robustness of Lead Reconstruction for Deep Brain Stimulation Modeling and Probabilistic Mapping.","authors":"Sabry L Barlatey, Alexis P R Terrapon, Gerd Tinkhauser, Ines Debove, Claudio Pollo, Andreas Nowacki","doi":"10.1159/000552349","DOIUrl":"10.1159/000552349","url":null,"abstract":"<p><strong>Introduction: </strong>Deep brain stimulation (DBS) has become an efficacious therapy for multiple indications. With the advent of directional leads, increasing stimulation options complexify manual programming. Therefore, automated programming algorithms based on probablisitic mapping are being tested for parameter prediction. Such approaches require computational lead reconstruction routines that are already broadly used. However, the robustness of lead reconstruction across distinct image sets of a same patient remains unclear.</p><p><strong>Methods: </strong>To assess lead reconstruction systematically, we identified retrospectively 34 DBS patients with Parkinson's disease (PD) or essential tremor, who received two distinct postoperative CT-scans. Each CT-scan was processed independently using the Lead-DBS toolbox. Between both image sets, we compared lead tip coordinates and volumes of tissue activation (VTA) for each hemisphere. Group-level probabilistic maps of clinical improvement were compared between sets for PD patients.</p><p><strong>Results: </strong>Mean lead tip translation between CTs was 0.79 mm (range: 0.21-2.35 mm). Pneumocephalus did not significantly affect reconstruction robustness. Lead translation was comparable in the patient native space and after normalization to the template brain. Individual-level VTA comparison revealed a mean Dice coefficient of 0.73 (range: 0.33-0.94), which decreased with lower amplitudes of stimulation. Group-level N-images and clinical improvement maps were robust (Dice coefficient, respectively, 0.88 and 0.90).</p><p><strong>Conclusion: </strong>Computational normalization and pneumocephalus correction were satisfying in our cohort. However, individual-level VTA variability was observed, potentially caused by slightly inaccurate CT-to-MRI co-registration or by brain shift sources other than pneumocephalus. These variabilities vanish at the group level, suggesting that current lead reconstruction routines are sufficient for probabilistic sweet spot identification.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"1-11"},"PeriodicalIF":2.1,"publicationDate":"2026-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13341085/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147821178","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psychiatric Neurosurgery: Attitude and Barriers of Psychiatrists toward Neurosurgical Interventions in Saudi Arabia.","authors":"Laila Alqahtani, Reem Abdulaziz Albuhairan, Mohammed Abdulmohsen Alsaif, Salem Suwailem Almutairi, Ola M Bin Shilash, Ziad S AlSaadi, Sami Khairy, Ahmed Alkhani","doi":"10.1159/000552222","DOIUrl":"10.1159/000552222","url":null,"abstract":"<p><strong>Introduction: </strong>Neurosurgical interventions such as deep brain stimulation (DBS), anterior capsulotomy, and anterior cingulotomy have been utilized since the mid-20th century and continue to play a role in the management of treatment-resistant psychiatric disorders, particularly major depressive disorder (MDD) and obsessive-compulsive disorder (OCD). Despite growing evidence supporting their safety and efficacy, psychiatrist engagement with these interventions remains limited, and data from many parts of the world is lacking. The objective of this study was to evaluate awareness, attitudes, and perceived barriers among psychiatrists in Saudi Arabia toward neurosurgical interventions for treatment-resistant psychiatric conditions.</p><p><strong>Methods: </strong>A survey-based study was conducted between March and June 2024 targeting senior psychiatry residents and board-certified psychiatrists practicing in Saudi Arabia. The questionnaire assessed sociodemographic information, referral practices, perceived knowledge, attitudes, and barriers related to psychiatric neurosurgery.</p><p><strong>Results: </strong>A total of 64 psychiatrists participated. While 68.8% agreed that neurosurgical interventions can be effective for selected cases, 79.7% had never referred a patient. Referral willingness was higher for OCD (60.9%) than MDD (31.3%). Key barriers included fear of irreversible complications (76.4%), lack of procedural knowledge (62.5%), and uncertainty about referral criteria (56.9%). Male gender and older age were significant predictors of referral behavior and positive attitudes. Despite the overall low referral rates, 32.8% expressed strong interest in learning more about these treatment options.</p><p><strong>Conclusion: </strong>Although modern psychiatric neurosurgery is supported by clinical evidence, its utilization among psychiatrists in Saudi Arabia is similar to that around the world. It remains limited due to knowledge gaps and safety concerns. Religious and cultural differences do not appear to play a significant role in psychiatrists' responses and attitudes toward psychiatric neurosurgery. Educational initiatives, interdisciplinary collaboration, and clearer referral criteria are essential to increase appropriate adoption and improve access for patients with severe, treatment-resistant psychiatric illnesses.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"1-10"},"PeriodicalIF":2.1,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147821197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feasibility of Nationwide Remote Chronic Neural Data Collection from Recording-Enabled Deep Brain Stimulation Systems.","authors":"Kasra A Mansourian, Ajay D Gandhi, Jonathan H Bentley, Kalman A Katlowitz, Danika L Paulo, Nisha Giridharan, Mohammed A Hasen, Tommy B Liu, Zain U Naqvi, Sarah S Soubra, Thomas A Hamre, Rick R Hanish, Eric A Storch, Wayne K Goodman, Sameer A Sheth, Nicole R Provenza","doi":"10.1159/000552017","DOIUrl":"10.1159/000552017","url":null,"abstract":"<p><strong>Introduction: </strong>Bidirectional deep brain stimulation (DBS) devices can continuously record neural activity while delivering stimulation. Due to memory limitations on the implanted device on which data are stored, frequent data downloads are required to prevent data loss. In this study, we present a novel collaborative data collection method utilizing a nationwide network of device representatives to allow frequent data transfer that reduces data loss without imposing travel burden on patients.</p><p><strong>Methods: </strong>We collected chronic neural data from nine patients with severe obsessive-compulsive disorder who received ventral capsule/ventral striatum DBS treatment between May 2023 and August 2024. We included patients implanted with the Medtronic Percept generator (either primary or rechargeable cell). Because most patients live at a distance from our center, our team worked in conjunction with patients and local device representatives to coordinate data acquisition meetings.</p><p><strong>Results: </strong>In total, we collected 40,080 h of neural data through in-person clinic visits (57.0%) and representative-facilitated remote downloads (43.0%). A team of seven device representatives completed 21 downloads across seven cities. Six of the nine patients completed ≥1 remote download. The percentage of potential data not captured was 54.8% (n = 3) among patients without remote downloads, compared to 29.1% (n = 6) among those with at least one remote download.</p><p><strong>Conclusion: </strong>Our data collection strategy helps mitigate the loss of neural data recorded on DBS devices for patients who live remote to the programming center and/or who visit the center infrequently. Nonetheless, challenges remain in ensuring regular downloads to prevent information loss. Implementation of automated downloads may further decrease data loss and patient burden.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"1-8"},"PeriodicalIF":2.1,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13177440/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147781725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What Is the Utility of 7 Tesla MRI for Deep Brain Stimulation Surgery? A Scoping Review.","authors":"Bryony K Ishihara, David Carmichael, Shaihan Malik, Thomas Barrick, Franklyn Howe, Erlick A C Pereira, Michael G Hart","doi":"10.1159/000552022","DOIUrl":"10.1159/000552022","url":null,"abstract":"<p><strong>Background: </strong>Effective deep brain stimulation (DBS) requires precise visualisation of the target on magnetic resonance imaging (MRI). However, on clinical 3 Tesla (T) MRI these targets are often imperfectly delineated, introducing potential error. Higher magnetic field strength, e.g., 7T MRI ought to improve visualisation via resolution or contrast. Our aim was to appraise current evidence for proposed improvements with 7T MRI for DBS implantation. Specifically, we wanted to consider evidence for improvements in target visualisation, the imaging sequences that can leverage improvements, and how better MRI quality translated into clinical outcomes.</p><p><strong>Summary: </strong>A scoping review was performed across multiple databases (PubMed and EMBASE). Search criteria included the terms (\"7 Tesla\" OR \"7T\") AND (\"deep brain stimulation\" OR \"thalamus\" OR \"basal ganglia\" OR \"globus pallidus\" OR \"zona incerta\" OR \"pedunculopontine\" OR \"subthalamic nucleus\"). Studies were selected based on target visualisation, sequence appraisal, or clinical application. Quantitative data were extracted for meta-analysis. 66 papers were identified. Target visualisation was improved with better signal- and contrast-to-noise ratio compared to 1.5T or 3T MRI, while manual segmentations of the subthalamic nucleus at 7T showed high inter-rater reliability (Dice = 0.75, 10 studies). Gradient echo sequences and quantitative susceptibility mapping offered the best demarcation and tissue contrast of basal ganglia structures. Clinical studies have demonstrating promising results with novel targets and targeting strategies, but not when simply implementing 7T MRI data in existing targeting approaches.</p><p><strong>Key messages: </strong>7T MRI offers objectively better data quality that translates to better delineation of DBS targets. However, to translate these benefits into improved clinical outcomes will require a development of DBS planning and targeting approaches rather than just utilising current practices. In the future, there is significant potential for establishing larger multi-centre series, exploring new sequences, and developing novel clinical trials to test for improvements in patient outcomes.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"1-11"},"PeriodicalIF":2.1,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147781723","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Choice of Neurosurgical Planning Software Affects Deep Brain Stimulation Target Coordinate Generation.","authors":"Michael G Hart, Redab Ahmad Alkhataybeh, Rahul S Shah, Adnan Shaikh, Abteen Mostofi, Erlick A C Pereira","doi":"10.1159/000551905","DOIUrl":"10.1159/000551905","url":null,"abstract":"<p><strong>Introduction: </strong>Targeting and coordinate derivation are critical steps in deep brain stimulation (DBS). Multiple planning stations are available to assist in this process, yet it is unclear how they compare in their methods and outputs. We hypothesised that planning DBS would generate the same coordinates independent of the planning station used.</p><p><strong>Methods: </strong>We compared the planning of DBS to the subthalamic nucleus (STN) using three planning stations (Brainlab Elements v2, Medtronic StealthStation™ S8, and Renishaw neuroinspire™ v6.2.2). Six users (2 consultants/attendings, 2 senior fellows, 2 clinical lecturers/senior residents) planned bilateral STN DBS for the same 10 randomly ordered subjects on each planning station in 3 spaces (native T2 image, AC-PC, stereotactic frame), generating 3,240 data points. Differences in individual XYZ coordinates were analysed per space using parametric statistical tests.</p><p><strong>Results: </strong>Mean coordinates in image space varied by 0.33 mm (Z-plane) between planning stations, with statistically significant differences in the X-plane (Brainlab) and Y- and Z-planes (Renishaw). Mean coordinates in AC-PC space varied by a maximum of 1.02 mm (Z-plane) with significant differences present in all 3 planes for Renishaw. Mean coordinates in stereotactic frame space varied by 0.53 mm (Z-plane) with differences present in the X-plane (Brainlab), Y-plane (Renishaw), and Z-plane (all). Between-rater and between-subject analyses did not reveal any significant differences.</p><p><strong>Conclusion: </strong>Differences in derived coordinates between planning station are present but small (mean <0.5 mm across all planes and spaces), albeit with a variance of 1.5 mm. Directions of effects were varied and likely represent a complex interaction of multiple processes. If changing between planning stations, we would recommend a prospective appraisal of lead placement and clinical outcomes. These data highlight that a critical appraisal of the methods used within planning stations is warranted to provide consistent coordinate derivation and improved targeting.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"1-9"},"PeriodicalIF":2.1,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147781711","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}