COMMENTARY Commentary: Susceptibility Sensitive Magnetic Resonance Imaging Displays Pallidofugal and Striatonigral Fiber Tracts Brian Harris Kopell, MD he authors present a comprehensive and for deep brain surgery may eventually replace detailed review of the radiographic anat- subcortical nucleus-based targeting. Jonathan J. Rasouli, MD Tomy of the pallidofugal and striatonigral The authors successfully demonstrate that 7-T Department of Neurosurgery, Mount Sinai fiber tracts as seen on susceptibility-based, high- magnetic resonance imaging allows visualization Health System, New York, New York resolution magnetic resonance imaging. Their of white matter pathways in vivo that were once findings are successfully presented in a manner visible only under a microscope. Indeed, this level Correspondence: that is both interesting and accessible to the of resolution may eventually be required in the Brian Harris Kopell, MD, Department of Neurosurgery, reader. Of note, the authors’ flawless description progressive evolution toward image-guided deep 3,4 Mount Sinai Health System, of the basal ganglia circuitry in the introduction brain surgery. Articles like this that improve Annenberg 8-37, is a particular highlight of this article. our understanding of the complex anatomy 1 Gustave L Levy Place, Parkinson disease is not simply an ailment of behind diseases such as Parkinson disease take New York, NY 10029. E-mail: email@example.com abnormal dopamine metabolism. The progres- us one step further to accomplishing this goal. sive evolution of the radiographic imaging of the Disclosure basal ganglia and the brainstem has allowed our Copyright © 2016 by the The authors have no personal, financial, or institutional collective knowledge of the motor circuit path- Congress of Neurological Surgeons. interest in any of the drugs, materials, or devices described in ways affected in Parkinson disease to continue to this article. improve in tandem. As neurosurgeons, our ability to continually improve motor outcomes in REFERENCES Parkinson disease through deep brain stimulation 1. Schneider TM, Deistung A, Biedermann U, et al. Susceptibility surgery is reliant on our ability to accurately and sensitive magnetic resonance imaging displays pallidofugal and precisely visualize subcortical targets such as the striatonigral fiber tracts. Oper Neurosurg. 2016;12(4):330-338. subthalamic nucleus and pallidum. Therefore, 2. Hartmann CJ, Lujan JL, Chaturvedi A, et al. Tractography activation patterns in dorsolateral prefrontal cortex suggest better one can infer that continual improvements in the clinical responses in OCD DBS. Front Neurosci. 2016;9:519. radiographic imaging of these structures are 3. Starr PA, Markun LC, Larson PS, et al. Interventional MRI- paramount to the progress of our field. Generally, guided deep brain stimulation in pediatric dystonia: first these motor pathways are not targeted directly; experience with the ClearPoint system. J Neurosurg Pediatr. 2014;14(4):400-408. however, improved visualization provides us with 4. Harries AM, Kausar J, Roberts SA, et al. Deep brain stimulation the ability to validate advanced imaging techni- of the subthalamic nucleus for advanced Parkinson disease using ques such as fiber tractography. In the future, the general anesthesia: long-term results. J Neurosurg. 2012;116(1): direct targeting of white matter motor pathways 107-113. OPERATIVE NEUROSURGERY VOLUME 12 | NUMBER 4 | DECEMBER 2016 | 339 Copyright © Congress of Neurological Surgeons. Unauthorized reproduction of this article is prohibited.
Operative Neurosurgery – Oxford University Press
Published: Dec 1, 2016
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