Diffusion Tensor Imaging-Based Thalamic Segmentation in Deep Brain Stimulation for Chronic Pain Conditions

Won Kim, Srinivas Chivukula, Jason Hauptman, Nader Pouratian

Research output: Contribution to journalArticlepeer-review

Abstract

Background/Aims: Thalamic deep brain stimulation (DBS) for the treatment of medically refractory pain has largely been abandoned on account of its inconsistent and oftentimes poor efficacy. Our aim here was to use diffusion tensor imaging (DTI)-based segmentation to assess the internal thalamic nuclei of patients who have undergone thalamic DBS for intractable pain and retrospectively correlate lead position with clinical outcome. Methods: DTI-based segmentation was performed on 5 patients who underwent sensory thalamus DBS for chronic pain. Postoperative computed tomography images obtained for electrode placement were fused with preoperative magnetic resonance images that had undergone DTI-based thalamic segmentation. Sensory thalamus maps of 4 patients were analyzed for lead positioning and interpatient variability. Results: Four patients who experienced significant pain relief following DBS demonstrated contact positions within the DTI-determined sensory thalamus or in its vicinity, whereas 1 patient who did not respond to stimulation did not. Only 4 voxels (2%) within the sensory thalamus were mutually shared among patients; 108 voxels (58%) were uniquely represented. Conclusions: DTI-based segmentation of the thalamus can be used to confirm thalamic lead placement relative to the sensory thalamus and may serve as a useful tool to guide thalamic DBS electrode implantation in the future.

Original languageEnglish (US)
Pages (from-to)225-234
Number of pages10
JournalStereotactic and Functional Neurosurgery
Volume94
Issue number4
DOIs
StatePublished - Oct 1 2016
Externally publishedYes

Keywords

  • Deep brain stimulation
  • Diffusion tensor imaging
  • Pain
  • Thalamic segmentation

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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