Intraoperative physiology augments atlas-based data in awake deep brain stimulation

Area of Science:

• Neurosurgery
• Neurology
• Medical Imaging

Background:

• Deep brain stimulation (DBS) surgery often involves awake patients for intraoperative neurophysiological testing to guide electrode placement.
• Atlas-based imaging, utilizing heat maps from prior patient data, aids in preoperative planning and intraoperative adjustments for DBS.
• Optimizing final electrode positioning is crucial for maximizing the efficacy of DBS treatment.

Purpose of the Study:

• To quantitatively analyze the impact of intraoperative testing and image-based data on DBS electrode positioning.
• To evaluate the value of combining neurophysiological testing with image-based guidance for optimizing DBS lead placement.
• To assess the correlation between intraoperative findings, electrode positioning, and long-term patient outcomes.

Main Methods:

• Retrospective analysis of data from 451 patients (822 DBS leads) treated between 2011 and 2021.
• Utilized atlas-based targeting, intraoperative microelectrode recording, macrostimulation data, and final lead coordinates.
• Reviewed patient records for active contact usage and neurologist-assessed outcomes at one year post-surgery.

Main Results:

• Microelectrode recording profiles varied by target and influenced macrostimulation testing locations.
• Macrostimulation response correlated with the selected final electrode trajectory.
• Atlas-based efficacy map centroids were proximate to active contacts and predicted one-year outcomes; improved outcomes were linked to better macrostimulation response.

Conclusions:

• Atlas-based imaging is valuable for DBS target planning and intraoperative guidance.
• Integrating intraoperative neurophysiological testing with atlas-based data during awake DBS optimizes electrode placement.
• This combined approach leads to individualized positioning and improved patient outcomes.