Deep Brain Stimulation: Techniques and Practices

 

Description:

The one-stop resource on deep brain stimulation for functional neurosurgeons!

Deep brain stimulation (DBS) is used to modulate dysfunctional circuits in the brain with stimulation pulses applied to specific target areas of the brain. Globally, DBS procedures have been most commonly performed for Parkinson's disease and essential tremor, but there are now new and growing research efforts studying DBS for psychiatric disorders and epilepsy.

Deep Brain Stimulation: Techniques and Practices written by the Society for Innovative Neuroscience in Neurosurgery along with Dr. William S. Anderson and distinguished experts presents the latest DBS approaches. The book begins with a history of DBS, general frame-based techniques, patient selection primarily for movement disorders, multidisciplinary collaboration, and ethical considerations. Subsequent chapters detail diverse technologies and disease-specific treatment for Parkinson's disease, essential tremor, dystonia, OCD, epilepsy, major depression, Tourette syndrome, emerging psychiatric indications, and pediatric applications.

Key highlights:

Lead placement techniques utilizing currently available customized platforms and robotics

Microelectrode recording and image-based direct targeting with MRI and CT to enhance lead placement

Lesioning methods including radiofrequency, and MR-guided focused ultrasound

Discussion of recent innovations in tractography to delineate white matter tracts in the brain and closed loop stimulation

DBS has helped thousands of patients with intractable conditions, allowing for a programmable therapy with durable treatment effect. This remarkable guide provides the essentials for functional neurosurgeons to pursue intraoperative research opportunities in this growing subspecialty and incorporate DBS into clinical practice.

 

Table of Contents:

 

1 Introduction to Deep Brain Stimulation: History, Techniques, and Ethical Considerations

1.1 Introduction

1.2 History of Deep Brain Stimulation

1.3 Ablative Procedures

1.4 Operative Techniques

1.4.1 Frame-based versus Frameless Approaches

1.4.2 Microelectrode Recording and Intraoperative Monitoring

1.4.3 Description of Surgical Procedure

1.5 Multidisciplinary Committees

1.6 Ethics

1.7 Conclusion

References

2 Customized Platform-Based Stereotactic DBS Lead Placement Technique (FHC STarFix, Medtronic Nexframe, and Robotic System Placement)

2.1 Background

2.2 Frame versus Imaging-based Coordinate Systems

2.2.1 Surgical Targeting Fixture (STarFix) Platform

2.2.2 Nexframe

2.2.3 Robotic Assisted Placement

2.3 System Comparison

References

3 Microelectrode Recording Methods

3.1 Introduction

3.2 The Rationale for Mapping

3.3 Microelectrode Technology and Technique

3.3.1 Ventral Thalamus

3.3.2 Globus Pallidus

3.3.3 Subthalamic Nucleus

3.4 Controversies and Complications

3.5 Summary

References

4 Intraoperative Imaging-Based Lead Implantation

4.1 Introduction

4.2 Evolution of Lead Implantation in the Asleep Patient

4.3 Intraoperative-CT-verified DBS

4.4 Intraoperative-MRI or Interventional-MRI-guided DBS

4.4.1 iMRI Environment

4.4.2 MRI Sequences for Anatomic Targeting

4.4.3 ClearPoint Workflow

4.5 Patient Selection for DBS Under General Anesthesia

4.6 Future Directions

References

5 Lesioning Methods for Movement Disorders

5.1 Introduction

5.2 Pallidotomy

5.3 Ventral Thalamotomy

5.4 Stereotactic Surgical Technique

5.5 Radiosurgical Lesioning Procedures

5.6 Laser Interstitial Thermal Therapy with MR Thermography

5.7 MR-guided Focused Ultrasound

5.8 Conclusion

References

6 Computational Modeling and Tractography for DBS Targeting

6.1 Introduction

6.2 Computational Modeling Techniques

6.2.1 Volume of Tissue Activated

6.2.2 Whole-Brain Network Models

6.2.3 Beyond Conventional Stimulation

6.3 Advanced Imaging Techniques

6.3.1 Diffusion-Weighted Imaging and Tractography

6.3.2 Advancements in Anatomic Imaging

6.4 Future Applications of Computational Modeling and Advanced Imaging

References

7 Closed-Loop Stimulation Methods: Current Practice and Future Promise

7.1 Introduction

7.2 Approaches to Closed-Loop Neuromodulation

7.2.1 Considerations for Designing an Optimal System

7.2.2 Sources of Feedback Signals

7.2.3 Control Systems and Stimulation Paradigms

7.3 Existing Technology Platforms and Clinical Data

7.3.1 Adaptive Deep Brain Stimulation

7.3.2 Closed-Loop Stimulation for Epilepsy

7.3.3 Closed-Loop Vagal Nerve Stimulation

7.3.4 Closed-Loop Spinal Cord Stimulation

7.4 Outstanding Questions and New Horizons

7.4.1 Effects of Closed-Loop Stimulation on the Underlying Mechanism of DBS

7.4.2 Accelerating Improvements in Control Algorithms Using Machine Learning

7.4.3 Using Multiple Feedback Signals

7.5 Conclusion

References

8 Parkinson’s Disease Application

8.1 Introduction

8.2 Patient Selection

8.3 Goals of Treatment

8.4 Target Selection

8.4.1 Less Frequently Used Targets

8.5 Benefits of DBS

8.6 Risks of DBS

8.7 Techniques

8.7.1 Frame-based Implantation

8.7.2 Frameless Implantation

8.7.3 Stereotactic Targeting: Subthalamic nucleus

8.7.4 Stereotactic Targeting: Globus Pallidus Pars Interna

8.7.5 Target Confirmation

8.8 After Surgery

8.9 Summary and Conclusion

References

9 Essential Tremor Application

9.1 Presentation

9.1.1 Classification of Essential Tremor

9.1.2 Tremor Severity

9.2 Genetics

9.3 Pathophysiology and Tremor Circuitry

9.4 Diagnostic Testing

9.4.1 Testing and Grading Scales for Essential Tremor

9.5 The Medical Management of Essential Tremor

9.6 Surgical Management of Essential Tremor

9.6.1 Surgical Patient Selection

9.6.2 Tremor Evaluation

9.6.3 Quality of Life

9.6.4 Comorbidities

9.6.5 Strength of Support System

9.7 Surgical Interventions

9.7.1 Deep Brain Stimulation – Stereotactic Frame

9.7.2 Target and Trajectory Planning

9.7.3 Intraoperative Recordings and Mapping

9.7.4 Postoperative Management and Complications

9.7.5 Complications

9.7.6 Deep Brain Stimulation – Frameless Techniques

9.8 Minimally Invasive Techniques

9.8.1 Gamma Knife Thalamotomy

9.8.2 High-Frequency Focused Ultrasound

9.9 Future directions

9.9.1 Image-Guided DBS Based on DTI versus Awake MER-Guided DBS

References

10 Deep Brain Stimulation for Dystonia—Clinical Review and Surgical Considerations

10.1 Introduction

10.2 Classification and Examination of Dystonias

10.2.1 Axis I—Clinical Considerations

10.2.2 Axis II—Etiological Considerations

10.2.3 Rating Scales

10.3 Medical Management

10.3.1 Physical and Supportive Therapy

10.3.2 Pharmacological Considerations

10.3.3 Botulinum Injections

10.4 Surgical Treatment

10.4.1 Deep Brain Stimulation

10.4.2 Postoperative Complications

10.4.3 Stimulation Side Effects

10.5 Outcomes and DBS Programming

10.5.1 Primary Generalized Dystonia

10.5.2 Focal Dystonia/Cervical Dystonia

10.5.3 Secondary Dystonia

10.5.4 Postulates on Mechanism of Action

10.5.5 DBS Programming and Stimulation Parameters

10.6 Conclusion

References

11 Deep Brain Stimulation for Obsessive Compulsive Disorder

11.1 Introduction

11.2 Development of Stereotactic Neurosurgery for OCD

11.3 OCD Pathophysiology

11.4 Development of Targets for DBS for OCD

11.5 Criteria for Candidacy

11.6 Efficacy of DBS for OCD

11.7 Adverse Events

11.8 Summary of Studies

11.9 Considerations for Trial Design

11.10 Future Directions

11.11 Conclusion

References

12 Deep Brain Stimulation in Epilepsy

12.1 Introduction

12.2 Cerebellum

12.2.1 Cerebellar Cortex Stimulation

12.2.2 Deep Cerebellar Nuclei

12.3 The Thalamus

12.3.1 Centromedian Nucleus

12.3.2 Anterior Nucleus of the Thalamus

12.4 Basal Ganglia

12.4.1 Subthalamic Nucleus

12.4.2 Caudate Nucleus

12.5 Hippocampus

12.6 Responsive Neurostimulation

12.7 Conclusion

References

13 Deep Brain Stimulation in Major Depression

13.1 Introduction

13.2 The Current State of DBS for Major Depression

13.2.1 Initial DBS Application to Depression: Targeting the Subcallosal Cingulate

13.2.2 Targeting the Nucleus Accumbens

13.2.3 Targeting the Ventral Capsule/Ventral Striatum

13.2.4 Targeting the Medial Forebrain Bundle

13.2.5 DBS for Bipolar Depression

13.2.6 Ongoing DBS trials

13.3 The Future of DBS for Major Depression

13.3.1 Depression is Heterogeneous and its Treatment is Susceptible to Placebo Response

13.3.2 Lessons from Randomized Controlled Trial Design

13.3.3 Confirming Functional Target Engagement—A Necessary Next Step?

13.3.4 Neuroethics of DBS for TRD

13.4 Conclusion

References

14 Deep Brain Stimulation in Tourette Syndrome

14.1 Introduction

14.2 Epidemiology of Tourette Syndrome

14.3 Characteristics of Tourette Syndrome

14.3.1 Comorbidities

14.3.2 Tic Measurement Scales

14.4 Pathophysiology of Tourette Syndrome

14.5 Treatment for Tourette Syndrome

14.5.1 History of Lesioning

14.5.2 Deep Brain Stimulation for Tourette Syndrome

14.5.3 Selection Criteria

14.6 Surgical Flow and DBS Lead Placement

14.7 Postoperative Programming of the Pulse Generator for the DBS System

14.8 Future Directions

References

15 Deep Brain Stimulation for Emerging Psychiatric Indications

15.1 Introduction

15.2 Anorexia Nervosa

15.3 Addiction and Substance Use Disorders

15.4 Aggressive and Self-Injurious Behavior

15.5 Post-traumatic Stress Disorder

15.6 Schizophrenia

15.7 Conclusion

References

16 Intraoperative Research during Deep Brain Stimulation Surgery

16.1 Introduction

16.2 Formulating Hypotheses

16.3 Patient Selection and IRB Approval

16.4 Equipment and Setup

16.5 Behavioral Task Control

16.6 Data Analysis

16.7 Image-Based Reconstruction of Recording Sites

16.7.1 Image Acquisition Considerations

16.7.2 Reconstructing the Recording Locations

16.7.3 Additional Image-Based Analyses

16.7.4 Diffusion-Weighted Imaging Analysis

16.8 Limitations

16.9 Conclusion

References

17 Deep Brain Stimulation: Techniques and Practice for Pediatrics Indications

17.1 Introduction

17.2 Pediatric Movement Disorders: Neurosurgical Emergencies

17.3 Dystonia

17.4 Spasticity

17.5 Tourette syndrome

17.6 Surgical Considerations

17.7 Illustrative Case of DBS Insertion

17.8 Further Directions

17.9 Some Pearls in Pediatric Functional Neurosurgery

References

18 Establishing a Deep Brain Stimulation Practice

18.1 Introduction

18.2 What Do I Actually Want?

18.2.1 What Do I want: Joining a Program, or Starting a Program?

18.2.2 What Do I want: Teaching, Research, Surgery?

18.2.3 What Do I Want: My Schedule?

18.3 Practice Types

18.3.1 Practice Types: Private Practice

18.3.2 Practice Types: Hospital-Employed

18.3.3 Practice Types: Academic

18.4 How to Get Started?

18.4.1 How to Get Started: Building Your Team?

18.4.2 How to Get Started: Other Team Members?

18.4.3 How to Get Started: Hospital Partnership?

18.4.4 How to Get Started: The Role of Industry?

18.4.5 How to Get Started: Community Outreach?

18.4.6 How to Get Started: Building Your Reputation?

18.5 Summary and Conclusion

References

Index

 

An aparitie	6 May 2019
Autor	William Anderson
Dimensiuni	27.94 x 21.59 cm
Editura	Thieme
Format	Hardcover
ISBN	9781626237971
Limba	Engleza
Nr pag	380