Determining the orientation angle of directional leads for deep brain stimulation using computed tomography and digital x‐ray imaging: A phantom study

Sitz, Alexander; Hoevels, Mauritius; Hellerbach, Alexandra; Gierich, Andreas; Luyken, Klaus; Dembek, Till A.; Klehr, Martin; Wirths, Jochen; Visser‐Vandewalle, Veerle; Treuer, Harald

doi:10.1002/mp.12424

Cited by 61 publications

(82 citation statements)

References 20 publications

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“…Those results are stable for polar angles of up to 60° (Fig. 4), which signifies a clear improvement compared to previously published methods [10]. The mean deviation in this study was –0.6 ± 1.5° (range: –5.4 to 4.2°) which corresponds to a 6-times lower standard deviation and range compared to the method published by Sitz et al [10] (mean deviation –0.2 ± 9.4°, range: –23 to 34°).…”

Section: Discussionsupporting

confidence: 64%

“…It was shown that the error induced in the projection values along the line connecting two edges of aligned high-contrast objects is always negative, and thus results in a clearly defined dark streak artifact [19]. While the orientation marker artifact consists of a single dark streak [10], the gaps between the segmented electrodes create a characteristic artifact consisting of six dark streaks (Fig. 1).…”

Section: Methodsmentioning

confidence: 99%

“…In the first step of our algorithm the lead trajectory angles and the marker orientation angle are determined as previously described [10]. Based on these angles a geometric model for the expected streak artifact pattern at the level of the segmented electrodes is calculated.…”

Section: Methodsmentioning

confidence: 99%

“…These two angles are commonly used in stereotactic surgery for probe guidance. Oblique lead positions result from both pitch and yaw angles and can be combined, resulting in the polar angle θ, the angle of the lead with the z axis [10]. The orientation angle γ is a new degree of freedom in directional DBS and describes the rotation of the lead.…”

Section: Methodsmentioning

confidence: 99%

“…For each phantom a ground truth orientation was defined using the stylet as a reference [10]. Statistical analysis was performed using R version 3.4.1 (www.r-project.org).…”

Section: Methodsmentioning

confidence: 99%

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DiODe: Directional Orientation Detection of Segmented Deep Brain Stimulation Leads: A Sequential Algorithm Based on CT Imaging

Hellerbach

Dembek

Hoevels

et al. 2018

Stereotact Funct Neurosurg

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Background: Directional deep brain stimulation (DBS) allows steering the stimulation in an axial direction which offers greater flexibility in programming. However, accurate anatomical visualization of the lead orientation is required for interpreting the observed stimulation effects and to guide programming. Objectives: In this study we aimed to develop and test an accurate and robust algorithm for determining the orientation of segmented electrodes based on standard postoperative CT imaging used in DBS. Methods: Orientation angles of directional leads (Cartesia^TM; Boston Scientific, Marlborough, MA, USA) were determined using CT imaging. Therefore, a sequential algorithm was developed that quantitatively compares the similarity of the observed CT artifacts with calculated artifact patterns based on the lead’s orientation marker and a geometric model of the segmented electrodes. Measurements of seven ground truth phantoms and three leads with 60 different configurations of lead implantation and orientation angles were analyzed for validation. Results: The accuracy of the determined electrode orientation angles was –0.6 ± 1.5° (range: –5.4 to 4.2°). This accuracy proved to be sufficiently high to resolve even subtle differences between individual leads. Conclusions: The presented algorithm is user independent and provides highly accurate results for the orientation of the segmented electrodes for all angular constellations that typically occur in clinical cases.

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Section: Discussionsupporting

confidence: 64%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

“…For each phantom a ground truth orientation was defined using the stylet as a reference [10]. Statistical analysis was performed using R version 3.4.1 (www.r-project.org).…”

Section: Methodsmentioning

confidence: 99%

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DiODe: Directional Orientation Detection of Segmented Deep Brain Stimulation Leads: A Sequential Algorithm Based on CT Imaging

Hellerbach

Dembek

Hoevels

et al. 2018

Stereotact Funct Neurosurg

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Probabilistic sweet spots predict motor outcome for deep brain stimulation in Parkinson disease

Dembek

Roediger

Horn

et al. 2019

Annals of Neurology

153

203

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ObjectiveTo investigate whether functional sweet spots of deep brain stimulation (DBS) in the subthalamic nucleus (STN) can predict motor improvement in Parkinson disease (PD) patients.MethodsStimulation effects of 449 DBS settings in 21 PD patients were clinically and quantitatively assessed through standardized monopolar reviews and mapped into standard space. A sweet spot for best motor outcome was determined using voxelwise and nonparametric permutation statistics. Two independent cohorts were used to investigate whether stimulation overlap with the sweet spot could predict acute motor outcome (10 patients, 163 settings) and long‐term overall Unified Parkinson's Disease Rating Scale Part III (UPDRS‐III) improvement (63 patients).ResultsSignificant clusters for suppression of rigidity and akinesia, as well as for overall motor improvement, resided around the dorsolateral border of the STN. Overlap of the volume of tissue activated with the sweet spot for overall motor improvement explained R2 = 37% of the variance in acute motor improvement, more than triple what was explained by overlap with the STN (R2 = 9%) and its sensorimotor subpart (R2 = 10%). In the second independent cohort, sweet spot overlap explained R2 = 20% of the variance in long‐term UPDRS‐III improvement, which was equivalent to the variance explained by overlap with the STN (R2 = 21%) and sensorimotor STN (R2 = 19%).InterpretationThis study is the first to predict clinical improvement of parkinsonian motor symptoms across cohorts based on local DBS effects only. The new approach revealed a distinct sweet spot for STN DBS in PD. Stimulation overlap with the sweet spot can predict short‐ and long‐term motor outcome and may be used to guide DBS programming. ANN NEUROL 2019;86:527–538

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Directional DBS increases side‐effect thresholds—A prospective, double‐blind trial

et al. 2017

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Determining the orientation angle of directional leads for deep brain stimulation using computed tomography and digital x‐ray imaging: A phantom study

Abstract: The results show that both imaging modalities can be used to determine lead orientation angles with high accuracy. CT is superior to x-ray imaging, but oblique leads (polar angle > 40°) show limited precision due to the current design of the directional marker.

Cited by 61 publications

References 20 publications

DiODe: Directional Orientation Detection of Segmented Deep Brain Stimulation Leads: A Sequential Algorithm Based on CT Imaging

DiODe: Directional Orientation Detection of Segmented Deep Brain Stimulation Leads: A Sequential Algorithm Based on CT Imaging

Probabilistic sweet spots predict motor outcome for deep brain stimulation in Parkinson disease

Directional DBS increases side‐effect thresholds—A prospective, double‐blind trial

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