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Factors affecting targeting accuracy in minimally invasive twist drill deep brain stimulation
Abteen Mostofi1, Teresa R Scott1, Bryony Kiyoka Ishihara1
1Department of Psychology and Neuroscience, City St George's, University of London, London, United Kingdom.
Surgical Neurology International
|December 18, 2025
Summary
Accurate deep brain stimulation (DBS) electrode placement is crucial. This study identified stereotactic frame type, second-side surgery, and coronal angle as key factors affecting DBS targeting accuracy.
Area of Science:
- Neurosurgery
- Medical Imaging
- Neurological Devices
Background:
- Deep brain stimulation (DBS) efficacy depends on precise stereotactic electrode placement.
- Post-implantation imaging is vital for assessing electrode position and targeting accuracy.
- This study investigates targeting accuracy factors using a minimally invasive twist drill technique, differing from the typical burr hole approach.
Purpose of the Study:
- To identify and analyze factors influencing targeting accuracy in deep brain stimulation (DBS) surgery.
- To quantify the trajectory error (TE) in DBS electrode placement.
- To provide insights for optimizing surgical workflows and improving DBS targeting accuracy.
Main Methods:
- Retrospective analysis of 86 patients (171 electrodes) who underwent DBS.
- Definition and comparison of various targeting error measures, focusing on trajectory error (TE).
- Multivariate mixed effects models were used to assess the impact of 17 demographic, clinical, and procedural variables on accuracy.
Main Results:
- Mean trajectory error (TE) was 1.4 ± 0.7 mm.
- Electrodes were consistently placed slightly medial, posterior, and superior to the intended targets.
- Stereotactic frame type, second-side implantation, and decreasing coronal approach angle significantly increased TE.
Conclusions:
- Multivariate analysis identified key factors influencing DBS targeting accuracy.
- Stereotactic frame, surgical side, and approach angle are significant contributors to targeting error.
- Routine targeting error analysis is recommended for neurosurgeons to audit and refine DBS procedures.
