Joshua Moll1, Hannah Bullock1, Sarah Marmol1, jenna hislop2, jonathan jagid1, Ihtsham Haq3, Corneliu Luca1
1University of Miami, 2Miami VAMC, 3University of Miami Miller School of Medicine
Objective:
To evaluate the utility of image guided DBS programming. We aimed to determine the correlation between optimal DBS electrode placement predicted by imaging guided software and clinician-determined monopolar review in PD patients with deep brain stimulation.
Background:
The current paradigm for DBS programming, monopolar review - an empirical technique that is a time-consuming process that can last 60-90 minutes for each lead and is performed in a dopaminergic-off state.
Recent developments in imaging software with detailed anatomical atlases allow visualization of each individual electrode in relation to the target structure. Pre-operative MRI and post-operative CT images are fused to determine the precise location of individual contacts and allows an unbiased determination of best contact and is associated with decreased programing time.
Design/Methods:
An automatic software algorithm (Brainlab, Munich) was used to fuse preoperative MRI with postoperative CT and visualize the location of each electrode inside the STN or GPI. Two independent reviewers assessed the fusion images generated for 50 patients who had undergone DBS lead placement for Parkinson’s disease.
Results:
Our analysis included 50 patients,13 with GPi and 37 with STN implants. The majority of GPi contacts (71%) deemed best during initial monopolar review correlated with those predicted by the software and had full submersion in the target. In the case of STN, a strong correlation with the software was present in 42% of the cases for the left leads. However, the right STN contacts used for monopolar review had the largest percentage (48%) with no submersion in the target per the software.
Conclusions:
Optimal DBS contacts were successfully predicted by fusion images generated by the Brainlab software in the majority of patients with GPi targets and appreciable percentage of STN targets. This may help guide the monopolar review of patients who have undergone placement of deep brain stimulation electrodes.