A novel methodology for localizing pallidal deep brain stimulation leads.

INTRODUCTION

Positioning of deep brain stimulation (DBS) leads is paramount for optimizing therapeutic efficacy in Parkinson's disease (PD) and dystonia. Quantitative determination of lead position remains essential; however, current atlas-based targeting and stereotactic coordinate methods, while informative, limit patient specificity afforded by high-resolution reconstruction and introduce subjective variability.

METHODS

We developed a novel pipeline in Unity™ to ingest 7T MRI-based reconstructions of DBS leads within the globus pallidus internus (GPi). Using anatomical landmarks and structure-specific algorithms, the GPi was parcellated into 12 anatomically-based subregions in a semi-automated, reproducible manner. Active contact positions were localized relative to a novel coordinate system developed from a GPi-based bounding box. A novel distance-to-border metric remapped contacts onto a common atlas (PD25) for population comparison against the same contacts mapped onto a common left GPi space using mid-commissural point (MCP) coordinates (Schaltenbrand-Wahren atlas).

RESULTS

Fifteen leads from 10 PD subjects were used for ellipsoid fitting of active contact locations, resulting in an elliptical volume of 38.94 mm3 when using MCP coordinates, compared to a volume of 5.08 mm3 with our GPi-specific coordinates. The mean distance-to-ellipse centroid was 3.45 ± 1.57 mm for MCP coordinates and 2.03 ± 0.82 for our GPi-specific coordinates. Our distance-to-border remapping metric yielded mean adjustments of 0.81 mm (y-axis) and 1.61 mm (z-axis). A subset of six GPi active contacts were plotted with post-DBS motor improvement scores, demonstrating the ability to link lead location with clinical outcomes.

CONCLUSION

Our novel software provides a quantifiable lead location with respect to the anatomical target, enhancing patient-specific lead localization by avoiding some of the pitfalls of either structure-to-atlas normalization or traditional stereotactic coordinates.