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Updated: Jan 19, 2026

Robotic Cochlear Implantation for Direct Cochlear Access
Published on: June 16, 2022
Directional DBS leads show large deviations from their intended implantation orientation
T A Dembek1, M Hoevels2, A Hellerbach2
1Department of Neurology, University Hospital of Cologne, Germany.
Objective:
Lead orientation is a new degree of freedom with directional deep brain stimulation (DBS) leads. We investigated how prevalent deviations from the intended implantation direction are in a large patient cohort.
Methods:
The Directional Orientation Detection (DiODe) algorithm to determine lead orientation from postoperative CT scans was implemented into the open-source Lead-DBS toolbox. Lead orientation was analyzed in 100 consecutive patients (198 leads). Different anatomical targets and intraoperative setups were compared.
Results:
Deviations of up to 90° from the intended implantation direction were observed. Deviations of more than 30° were seen in 42% of the leads and deviations of more than 60° in about 11% of the leads. Deviations were independent from the neuroanatomical target and the stereotactic frame but increased depending on which microdrive was used.
Discussion:
Our results indicate that large deviations from the intended implantation direction are a common phenomenon in directional leads. Postoperative determination of lead orientation is thus mandatory for investigating directional DBS.
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