Lead-OR: A Multimodal Platform for Deep Brain Stimulation Surgery

Abstract

Deep Brain Stimulation (DBS) electrode implant trajectories are stereotactically defined using preoperative neuroimaging. To validate the correct trajectory, microelectrode recordings (MER) can be used to match the neuroanatomy with expected neurophysiological activity patterns, commonly using up to five trajectories in parallel. However, understanding their location in relationship to basal ganglia anatomy can be challenging. Here we present a tool that integrates resources from stereotactic planning, neuroimaging, MER and high-resolution atlas data to create a real-time visualization of the implant trajectory. We show a general correspondence between features derived from neuroimaging and electrophysiological recordings and present example use cases that demonstrate the functionality of the tool. The software toolbox is made openly available, extendable and holds translational potential in the field of stereotactic neurosurgery.

Optimal Stimulation Sites and Networks for Deep Brain Stimulation of the Fornix in Alzheimer’s Disease

“…In this regard, we were not able to find apparent differences in i) electrode placement or ii) fiber-score activations between patients younger than versus older than 65, which suggests other factors might have influenced the clinical outcome in the younger group (Figure S10). As previously reported, possible explanations for the decline in early onset subjects include a more aggressive presentation of the condition, greater brain atrophy and comparably more reduced glucose metabolism in this subgroup of patients 29,60,66,67 .…”

“…Each processing step was meticulously monitored and corrected, if necessary. In addition, we applied a first-of-its kind manual refinement of normalization warp fields 67 , which was crucial to yield accurate registrations due to large variabilities in patient anatomy. A demonstration of this labor-intensive manual refinement process is visualized in video S1, which shows that upon manual refinements, a good registration accuracy between patient and template fornices was achieved.…”

“…For the present study, this was crucial, since in the field of DBS, electrode displacements of a few millimeters will lead to substantially different effects 35,37 . To account for this, we applied a novel method, termed WarpDrive 67 , to manually refine registrations into template space (see video S1). Briefly, WarpDrive provides a graphical interface allowing precise alignment of source and target landmarks by directly visualizing the normalized images, together with the template and atlases in MNI space (the software is openly available here: https://github.com/netstim/SlicerNetstim).…”

Optimal deep brain stimulation sites and networks for stimulation of the fornix in Alzheimer’s disease

“…Each processing step was meticulously monitored and corrected, if necessary. In addition, we applied a recently introduced manual refinement of normalization warp fields 65 , which was crucial to yield accurate registrations due to large variabilities in patient anatomy. A demonstration of this laborintensive manual refinement process is visualized in supplementary video 1, which shows that upon manual refinements, a good registration accuracy between patient and template fornices was achieved.…”

Lead-DBS v3.0: Mapping deep brain stimulation effects to local anatomy and global networks

“…Accuracy of Lead-DBS derived electrode reconstructions was electrophysiologically validated in recent publications from four different groups (Al Awadhi et al, 2022;Nowacki et al, 2018;Oxenford et al, 2021;Rappel et al, 2020). Furthermore, the open-source nature of Lead-DBS and its broad application across continents may foster standardization, or -to paraphrase Latorre et al -a growing democratization and increased speed of advances in the field (Latorre et al, 2021).…”