BACKGROUND Endovascular delivery of current using 'stentrodes' - electrode bearing stents - constitutes a potential alternative to conventional deep brain stimulation (DBS). The precise neuroanatomical relationships between DBS targets and the vascular system, however, are poorly characterized to date. OBJECTIVE To establish the relationships between cerebrovascular system and DBS targets and investigate the feasibility of endovascular stimulation as an alternative to DBS. METHODS Neuroanatomical targets as employed during deep brain stimulation (anterior limb of the internal capsule, dentatorubrothalamic tract, fornix, globus pallidus pars interna, medial forebrain bundle, nucleus accumbens, pedunculopontine nucleus, subcallosal cingulate cortex, subthalamic nucleus, and ventral intermediate nucleus) were superimposed onto probabilistic vascular atlases obtained from 42 healthy individuals. Euclidian distances between targets and associated vessels were measured. To determine the electrical currents necessary to encapsulate the predefined neurosurgical targets and identify potentially side-effect inducing substrates, a preliminary volume of tissue activated (VTA) analysis was performed. RESULTS Six out of ten DBS targets were deemed suitable for endovascular stimulation: medial forebrain bundle (vascular site: P1 segment of posterior cerebral artery), nucleus accumbens (vascular site: A1 segment of anterior cerebral artery), dentatorubrothalamic tract (vascular site: s2 segment of superior cerebellar artery), fornix (vascular site: internal cerebral vein), pedunculopontine nucleus (vascular site: lateral mesencephalic vein), and subcallosal cingulate cortex (vascular site: A2 segment of anterior cerebral artery). While VTAs effectively encapsulated mfb and NA at current thresholds of 3.5V and 4.5V respectively, incremental amplitude increases were required to effectively cover fornix, PPN and SCC target (mean voltage: 8.2 ± 4.8 V, range: 3.0 - 17.0 V). The side-effect profile associated with endovascular stimulation seems to be comparable to conventional lead implantation. Tailoring of targets towards vascular sites, however, may allow to reduce adverse effects, while maintaining the efficacy of neural entrainment within the target tissue. CONCLUSIONS While several challenges remain at present, endovascular stimulation of select DBS targets seems feasible offering novel and exciting opportunities in the neuromodulation armamentarium.

中文翻译：

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血管内深部脑刺激：研究血管结构与脑深部刺激目标之间的关系

背景技术使用“支架”——带有电极的支架——的电流的血管内递送构成了传统深部脑刺激（DBS）的潜在替代方案。然而，DBS 目标和血管系统之间精确的神经解剖学关系迄今为止还没有得到很好的表征。目的建立脑血管系统与DBS靶点的关系，探讨血管内刺激替代DBS的可行性。方法 深部脑刺激期间采用的神经解剖学目标（内囊前肢、齿突丘脑束、穹窿、苍白球内部、内侧前脑束、伏隔核、桥脑桥核、胼胝体下扣带皮层、丘脑底核、和腹侧中间核）被叠加到从 42 个健康个体获得的概率血管图谱上。测量目标和相关血管之间的欧几里得距离。为了确定封装预定神经外科目标所需的电流并确定潜在的副作用诱发底物，进行了组织激活 (VTA) 的初步体积分析。结果 十分之六的 DBS 靶点被认为适合血管内刺激：内侧前脑束（血管部位：大脑后动脉 P1 段）、伏核（血管部位：大脑前动脉 A1 段）、齿状丘脑束（血管部位：s2小脑上动脉段）、穹窿（血管部位：大脑内静脉）、桥脚核（血管部位：中脑外侧静脉）和胼胝体扣带回皮层（血管部位：大脑前动脉 A2 段）。虽然 VTA 分别在 3.5V 和 4.5V 的电流阈值下有效地封装了 mfb 和 NA，但需要增加幅度以有效覆盖穹窿、PPN 和 SCC 目标（平均电压：8.2 ± 4.8 V，范围：3.0 - 17.0 V）。与血管内刺激相关的副作用似乎与传统的导线植入相当。然而，针对血管部位定制目标可以减少不利影响，同时保持目标组织内神经夹带的功效。结论 虽然目前仍存在一些挑战，但选定 DBS 目标的血管内刺激似乎是可行的，为神经调节设备提供了新的和令人兴奋的机会。