T A Dembek1, M Hoevels2, A Hellerbach3, A Horn4, J N Petry-Schmelzer5, J Borggrefe6, J Wirths7, H S Dafsari8, M T Barbe9, V Visser-Vandewalle10, H Treuer11. 1. Department of Neurology, University Hospital of Cologne, Germany. Electronic address: till.dembek@uk-koeln.de. 2. Department of Stereotactic and Functional Neurosurgery, University Hospital of Cologne, Germany. Electronic address: mauritius.hoevels@uk-koeln.de. 3. Department of Stereotactic and Functional Neurosurgery, University Hospital of Cologne, Germany. Electronic address: alexandra.hellerbach@uk-koeln.de. 4. Movement Disorders & Neuromodulation Unit, Department for Neurology, Charité - University Medicine Berlin, Germany. Electronic address: andreas.horn@charite.de. 5. Department of Neurology, University Hospital of Cologne, Germany. Electronic address: jan.petry-schmelzer@uk-koeln.de. 6. Division of Neuroradiology, Institute of Diagnostic and Interventional Radiology, University Hospital of Cologne, Germany. Electronic address: jan.borggrefe@uk-koeln.de. 7. Department of Stereotactic and Functional Neurosurgery, University Hospital of Cologne, Germany. Electronic address: jochen.wirths@uk-koeln.de. 8. Department of Neurology, University Hospital of Cologne, Germany; National Parkinson Foundation International Centre of Excellence, King's College London, United Kingdom. Electronic address: haidar.salimi-dafsari@uk-koeln.de. 9. Department of Neurology, University Hospital of Cologne, Germany. Electronic address: michael.barbe@uk-koeln.de. 10. Department of Stereotactic and Functional Neurosurgery, University Hospital of Cologne, Germany. Electronic address: veerle.visser-vandewalle@uk-koeln.de. 11. Department of Stereotactic and Functional Neurosurgery, University Hospital of Cologne, Germany. Electronic address: harald.treuer@uk-koeln.de.
Abstract
OBJECTIVE: Lead orientation is a new degree of freedom with directional deep brain stimulation (DBS) leads. We investigated how prevalent deviations from the intended implantation direction are in a large patient cohort. METHODS: The Directional Orientation Detection (DiODe) algorithm to determine lead orientation from postoperative CT scans was implemented into the open-source Lead-DBS toolbox. Lead orientation was analyzed in 100 consecutive patients (198 leads). Different anatomical targets and intraoperative setups were compared. RESULTS: Deviations of up to 90° from the intended implantation direction were observed. Deviations of more than 30° were seen in 42% of the leads and deviations of more than 60° in about 11% of the leads. Deviations were independent from the neuroanatomical target and the stereotactic frame but increased depending on which microdrive was used. DISCUSSION: Our results indicate that large deviations from the intended implantation direction are a common phenomenon in directional leads. Postoperative determination of lead orientation is thus mandatory for investigating directional DBS.
OBJECTIVE: Lead orientation is a new degree of freedom with directional deep brain stimulation (DBS) leads. We investigated how prevalent deviations from the intended implantation direction are in a large patient cohort. METHODS: The Directional Orientation Detection (DiODe) algorithm to determine lead orientation from postoperative CT scans was implemented into the open-source Lead-DBS toolbox. Lead orientation was analyzed in 100 consecutive patients (198 leads). Different anatomical targets and intraoperative setups were compared. RESULTS: Deviations of up to 90° from the intended implantation direction were observed. Deviations of more than 30° were seen in 42% of the leads and deviations of more than 60° in about 11% of the leads. Deviations were independent from the neuroanatomical target and the stereotactic frame but increased depending on which microdrive was used. DISCUSSION: Our results indicate that large deviations from the intended implantation direction are a common phenomenon in directional leads. Postoperative determination of lead orientation is thus mandatory for investigating directional DBS.
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