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.2012 Apr 24:6:15.
doi: 10.3389/fnint.2012.00015. eCollection 2012.

"Connectomic surgery": diffusion tensor imaging (DTI) tractography as a targeting modality for surgical modulation of neural networks

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"Connectomic surgery": diffusion tensor imaging (DTI) tractography as a targeting modality for surgical modulation of neural networks

Jaimie M Henderson. Front Integr Neurosci..

Abstract

Deep brain stimulation (DBS) is being used to treat a growing number of neurological disorders. Until recently, DBS has been thought to act mainly by suppressing local neuronal activity, essentially producing a functional lesion. Numerous studies are now demonstrating that DBS has widespread network effects mediated by white matter pathways. The new science of connectomics aims to map the connectivity between brain regions in health and disease. Targeting DBS specifically to pathways which exhibit pathological connectivity could greatly expand the possibilities for treating brain diseases. This brief review examines the current state of brain imaging for visualization of these networks and describes how DBS might be used to restore normal connectivity in pathological states.

Keywords: connectomics; deep brain stimulation; default mode network; diffusion tensor imaging; tractography.

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Figures

Figure 1
Figure 1
Oscillatory coherence demonstrated between cortex and subthalamic nucleus during DBS surgery. A six contact cortical strip recording electrode (open circles) was introduced through a 14 mm burrhole to arrive at the origin of the hyperdirect pathway (denoted in orange) as defined by DTI tractography. Electrocorticographic recordings demonstrate oscillatory coherence at 22 Hz (“beta” frequency range), most strongly between the subthalamic nucleus (STN) and the pair of electrodes straddling the origin of the hyperdirect pathway (Henderson et al., 2010).
Figure 2
Figure 2
Postoperative CT scan demonstrating deep brain stimulation electrodes placed in the Vim nucleus of the thalamus for the treatment of tremor. DTI tractography of the dentatorubrothalamic tract (DRT) is superimposed on the CT scan, and is indicated in green on the left side (corresponding to the radiographic right side of the brain) and in red on the right side (radiographic left side of the brain). Note the position of the DBS lead on the right side of the brain lies within the DRT and provided symptomatic relief, whereas the DBS lead on the left side of the brain is located outside the DRT and did not provide symptomatic relief.
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