Choice of Neurosurgical Planning Software Affects Deep Brain Stimulation Target Coordinate Generation

Targeting and coordinate derivation are critical steps in deep brain stimulation (DBS). Multiple planning stations are available to assist in this process, yet it is unclear how they compare in their methods and outputs. We hypothesised that planning DBS would generate the same coordinates independent of the planning station used.

We compared the planning of DBS to the subthalamic nucleus (STN) using three planning stations (Brainlab Elements v2, Medtronic StealthStation™ S8, and Renishaw neuroinspire™ v6.2.2). Six users (2 consultants/attendings, 2 senior fellows, 2 clinical lecturers/senior residents) planned bilateral STN DBS for the same 10 randomly ordered subjects on each planning station in 3 spaces (native T2 image, AC-PC, stereotactic frame), generating 3,240 data points. Differences in individual XYZ coordinates were analysed per space using parametric statistical tests.

Mean coordinates in image space varied by 0.33 mm (Z-plane) between planning stations, with statistically significant differences in the X-plane (Brainlab) and Y- and Z-planes (Renishaw). Mean coordinates in AC-PC space varied by a maximum of 1.02 mm (Z-plane) with significant differences present in all 3 planes for Renishaw. Mean coordinates in stereotactic frame space varied by 0.53 mm (Z-plane) with differences present in the X-plane (Brainlab), Y-plane (Renishaw), and Z-plane (all). Between-rater and between-subject analyses did not reveal any significant differences.

Differences in derived coordinates between planning station are present but small (mean <0.5 mm across all planes and spaces), albeit with a variance of 1.5 mm. Directions of effects were varied and likely represent a complex interaction of multiple processes. If changing between planning stations, we would recommend a prospective appraisal of lead placement and clinical outcomes. These data highlight that a critical appraisal of the methods used within planning stations is warranted to provide consistent coordinate derivation and improved targeting.