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A 3-D brain stem model created with 7T MRI could end trial-and-error surgery

por Lauren Dubinsky, Senior Reporter | June 04, 2015
Courtesy of Dr. Evan Calabrese
of Duke Medicine
Remember when paper road maps were replaced with real time GPS technology? Well, a similar change may soon be coming to the health care industry.

Researchers at Duke Medicine have developed a 3-D model of the human brain stem using 7T MRI technology, and it may do away with trial-and-error surgery for implanting electrodes. This model will better guide deep brain stimulation (DBS) procedures for tremors and Parkinson’s disease.

"As time goes on, imaging will only continue to get better," Dr. Nandan Lad, director of the Duke NeuroOutcomes Center, said in a statement. "We are well-equipped and at the cutting edge of understanding how to apply this technology, and will be in an even better position to treat more patients with fewer side effects."
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The researchers used a 7T MRI system to produce a 10-day scan of a healthy donor’s postmortem brain stem and then converted it into a 3-D model using a high-performance computing cluster, which is an open source, data-intensive computing system platform. The 3-D model can then be scaled to match a patient’s individual brain anatomy.

Currently, many surgeons use lower resolution CT and MRI scans and geographic coordinates proportionate to the planes of the brain to help them place electrodes in the patient’s thalamus. But with conventional imaging technology, the thalamus appears as a gray mass and the surgeons can only see the borders.

Often times the surgeons will have to remove and reinsert the electrodes and test frequencies in order to find the regions in the thalamus where the electric current suppresses hand tremors. But with the 3-D model, the surgeons can see actual details of the thalamus and the underlying circuitry.

The researchers conducted a retrospective study involving a dozen patients who have already been treated successfully with DBS for tremors to assess the model’s accuracy. They used the model to predict the best placement for the electrodes in each patient and found that 22 of 24 electrodes were placed successfully.

A prospective study using the 3-D model to guide DBS surgery will soon be conducted. The researchers are also looking to produce high-resolution imaging of other circuits in the brain, brain stem, and spinal cord, to develop treatments for other conditions including Alzheimer’s disease, neuropathic pain, depression, and obsessive-compulsive disorders.

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