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Model-Based Image Updating for Brain Shift in Deep Brain Stimulation Electrode Placement Surgery.

Chen Li, Xiaoyao Fan, Jennifer Hong

    IEEE Transactions on Bio-Medical Engineering
    |April 29, 2020
    PubMed
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    This study developed a biomechanical model to update CT scans, compensating for brain shift during deep brain stimulation (DBS) surgery. The method improved electrode targeting accuracy, particularly in cases with significant brain deformation.

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    Area of Science:

    • Neurosurgery
    • Medical Imaging
    • Biomechanical Modeling

    Background:

    • Accurate electrode placement is critical for deep brain stimulation (DBS) efficacy.
    • Intraoperative brain shift can degrade the accuracy of electrode placement during DBS surgery.
    • Current stereotactic frames may not fully account for brain shift, impacting surgical precision.

    Purpose of the Study:

    • To adapt a biomechanical model for estimating whole brain displacements.
    • To generate an updated CT (uCT) that compensates for intraoperative brain shift.
    • To evaluate the accuracy of the uCT in improving electrode targeting during DBS.

    Main Methods:

    • A biomechanical model was employed to estimate brain displacements using frontal cortical surface deformation data.
    • Preoperative CT (preCT) scans were deformed to create updated CT (uCT) images.
    • Fifteen patients undergoing bilateral DBS surgery were retrospectively analyzed, comparing TREs of preCT and uCT against post-placement CT (postCT).

    Main Results:

    • In patients with large brain deformation (Group L), the uCT significantly reduced Target Registration Error (TRE) at the Anterior Commissure (AC) from 1.85 ± 0.17 mm to 1.11 ± 0.13 mm.
    • The model updating approach improved AC localization accuracy but did not significantly alter TREs at the Posterior Commissure (PC).
    • Average TREs for uCT at PC were 1.07 ± 0.38 mm compared to 0.92 ± 0.52 mm for preCT in Group L.

    Conclusions:

    • This preliminary study suggests that the model-based image updating method can compensate for brain shift during DBS surgery.
    • The approach shows potential for improving targeting accuracy around critical surgical sites.
    • Further investigation is warranted to confirm the efficacy and clinical utility of this image updating technique.