Computer-aided placement of deep brain stimulators: from planning to intraoperative guidance

Stereotactic implantation of deep brain stimulation electrodes: a review of technical systems, methods and emerging tools

“…In general fiducials are affixed to the skull of the patient via a stereotactic system in order to introduce a reference system to the images. Different frameless fiducial systems for DBS implantation have been described and compared with frame based systems [9,13,24,30,56,75,102] but stereotactic frame based systems remain the gold standard. In consequence, this article will concentrate on the procedures using the stereotactic frame.…”

“…In general, these measurements are performed in millimetre steps before reaching the target and often measurements even go beyond the target structure. Most centres using microelectrode recording perform, as well, intraoperative stimulation along the trajectory using the microelectrodes stimulating in the microampere range [24,32,110] or macroelectrodes stimulating in the milliampere range for example using RF-or DBS stimulation electrodes [13,88,106]. In general this is done at the same measurement points as for MER, to evaluate the clinical effects with increasing stimulation voltage and to determine symptom reduction, the clinical therapeutic and side effect thresholds at each measurement point.…”

“…In this way surgical planning, guided implantation and final electrode position check is performed intraoperatively. Other alternatives to the traditional frames are the Eljamel-Tulley stereotactic cube [30] and the STarFix microtargeting Platform [9,24]. The STarFix platform uses titanium anchors which are implanted into the patient's skull before imaging.…”

“…The StimPilot Software (Medtronic Inc., Minneapolis, MN) [53] allowed a combined visualisation of short MER recordings together with the anatomical information but it is only commercialised in the US. Only few groups use homemade software for online data collection and visualisation [24,41,77]. Most of them use electrophysiological databases of several patients taking into account MER and rarely as well test stimulation results which are non-rigidly registered to the patient's MRI in order to predict preoperative target points.…”

Correlating Clinical Scores with Anatomical Electrodes Locations for Assessing Deep Brain Stimulation

“…The spatial normalisation allows performing retrospective studies, where statistical techniques are used to study anatomical or functional variability between patients. Response to stimulation, electro-physiological recordings, and clinical scores related to motor or cognitive evolution are all possible information that can be integrated in such atlases [7,8,9,10]. This fusion of information permits to understand functional organization within deep brain structures that helps for the identification of the optimal zone of therapy.…”