Abstract
The success of deep brain stimulation (DBS) relies primarily on the localization of the implanted electrode. Its final position can be chosen based on the results of intraoperative microelectrode recording (MER) and stimulation tests. The optimal position often differs from the final one selected for chronic stimulation with the DBS electrode. The aim of the study was to investigate, using finite element method (FEM) modeling and simulations, whether lead design, electrical setup, and operating modes induce differences in electric field (EF) distribution and in consequence, the clinical outcome. Finite element models of a MER system and a chronic DBS lead were developed. Simulations of the EF were performed for homogenous and patient-specific brain models to evaluate the influence of grounding (guide tube vs. stimulator case), parallel MER leads, and non-active DBS contacts. Results showed that the EF is deformed depending on the distance between the guide tube and stimulating contact. Several parallel MER leads and the presence of the non-active DBS contacts influence the EF distribution. The DBS EF volume can cover the intraoperatively produced EF, but can also extend to other anatomical areas. In conclusion, EF deformations between stimulation tests and DBS should be taken into consideration as they can alter the clinical outcome.
Highlights
Deep brain stimulation (DBS) is an established surgical therapy to treat the symptoms from movement disorders such as Parkinson’s disease, essential tremor, and dystonia [1,2,3]
Before the intraoperative stimulation tests are performed, a first path is made to record the activity with the microelectrode recording (MER) tip along the pre-planned trajectory; afterwards, the MER tip is retracted some millimeters inside the stimulation macroelectrode
The main the influence of grounding the guide tube is the presence of an electric field (EF) around it
Summary
Deep brain stimulation (DBS) is an established surgical therapy to treat the symptoms from movement disorders such as Parkinson’s disease, essential tremor, and dystonia [1,2,3]. The extension in space of the stimulation depends on several factors, including the surrounding tissue properties, the electrode design, and the stimulation parameters [4]. The success of the surgery is highly dependent on the correct electrode placement, which requires the utmost accuracy in the targeting stage. Due to difficulties in the visualization of some structures with conventional magnetic resonance imaging (MRI), a common procedure to confirm or refine the localization of the target before the insertion of the permanent DBS lead, is to monitor the deep brain structures along the pre-planned
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