Anatomical targeting for electrode localization in subthalamic nucleus deep brain stimulation: A comparative study

Thomas Tonroe; Hugh McDermott; Patrick Pearce; Nicola Acevedo; Wesley Thevathasan; San San Xu; Kristian Bulluss; Thushara Perera

doi:10.1111/jon.13133

Anatomical targeting for electrode localization in subthalamic nucleus deep brain stimulation: A comparative study

J Neuroimaging. 2023 Sep-Oct;33(5):792-801. doi: 10.1111/jon.13133. Epub 2023 Jun 8.

Authors

Thomas Tonroe^{1

2}, Hugh McDermott^{1

3

4}, Patrick Pearce^{1

5}, Nicola Acevedo^{1

6}, Wesley Thevathasan^{1

3

7

8

9

10}, San San Xu^{1

4

7}, Kristian Bulluss^{1

3

5

10

11

12}, Thushara Perera^{1

3

4}

Affiliations

¹ Bionics Institute, East Melbourne, Victoria, Australia.
² School of Engineering, RMIT University, Melbourne, Victoria, Australia.
³ DBS Technologies Pty Ltd, East Melbourne, Victoria, Australia.
⁴ Medical Bionics Department, The University of Melbourne, East Melbourne, Victoria, Australia.
⁵ Department of Neurosurgery, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia.
⁶ Centre for Mental Health, Swinburne University of Technology, Melbourne, Victoria, Australia.
⁷ Department of Neurology, Austin Hospital, Heidelberg, Victoria, Australia.
⁸ Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia.
⁹ Department of Neurology, The Royal Melbourne Hospital, Parkville, Victoria, Australia.
¹⁰ Department of Neurosurgery, Cabrini Hospital, Malvern, Victoria, Australia.
¹¹ Department of Neurosurgery, Austin Hospital, Heidelberg, Victoria, Australia.
¹² Department of Surgery, The University of Melbourne, Parkville, Victoria, Australia.

Abstract

Background and purpose: In deep brain stimulation (DBS), accurate electrode placement is essential for optimizing patient outcomes. Localizing electrodes enables insight into therapeutic outcomes and development of metrics for use in clinical trials. Methods of defining anatomical targets have been described with varying accuracy and objectivity. To assess variability in anatomical targeting, we compare four methods of defining an appropriate target for DBS of the subthalamic nucleus for Parkinson's disease.

Methods: The methods compared are direct visualization, red nucleus-based indirect targeting, mid-commissural point-based indirect targeting, and automated template-based targeting. This study assessed 226 hemispheres in 113 DBS recipients (39 females, 73 males, 62.2 ± 7.7 years). We utilized the electrode placement error (the Euclidean distance between the defined target and closest DBS electrode) as a metric for comparative analysis. Pairwise differences in electrode placement error across the four methods were compared using the Kruskal-Wallis H-test and Wilcoxon signed-rank tests.

Results: Interquartile ranges of the differences in electrode placement error spanned 1.18-1.56 mm. A Kruskal-Wallis H-test reported a statistically significant difference in the median of at least two groups (H(5) = 41.052, p < .001). Wilcoxon signed-rank tests reported statistically significant difference in two comparisons: direct visualization versus red nucleus-based indirect, and direct visualization versus automated template-based methods (T < 9215, p < .001).

Conclusions: All methods were similarly discordant in their relative accuracy, despite having significant technical differences in their application. The differing protocols and technical aspects of each method, however, have the implication that one may be more practical depending on the clinical or research application at hand.

Keywords: Parkinson's disease; anatomical targeting; automation; deep brain stimulation; electrode localization; neuroimaging; subthalamic nucleus.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Deep Brain Stimulation* / methods
Electrodes
Female
Humans
Magnetic Resonance Imaging
Male
Neurosurgical Procedures / methods
Parkinson Disease* / therapy
Subthalamic Nucleus* / physiology