title: Improving targeting in image-guided frame-based deep brain stimulation.
abstract: BACKGROUND
  Deep brain stimulation (DBS) is commonly used in the treatment of movement disorders such as Parkinson disease (PD), dystonia, and other tremors.
  
  
  OBJECTIVE
  To examine systematic errors in image-guided DBS electrode placement and to explore a calibration strategy for stereotactic targeting.
  
  
  METHODS
  Pre- and postoperative stereotactic MR images were analyzed in 165 patients. The perpendicular error between planned target coordinates and electrode trajectory was calculated geometrically for all 312 DBS electrodes implanted. Improvement in motor unified PD rating scale III subscore was calculated for those patients with PD with at least 6 months of follow-up after bilateral subthalamic DBS.
  
  
  RESULTS
  Mean (standard deviation) scalar error of all electrodes was 1.4(0.9) mm with a significant difference between left and right hemispheres. Targeting error was significantly higher for electrodes with coronal approach angle (ARC) ≥10° (P < .001). Mean vector error was X: -0.6, Y: -0.7, and Z: -0.4 mm (medial, posterior, and superior directions, respectively). Targeting error was significantly improved by using a systematic calibration strategy based on ARC and target hemisphere (mean: 0.6 mm, P < .001) for 47 electrodes implanted in 24 patients. Retrospective theoretical calibration for all 312 electrodes would have reduced the mean (standard deviation) scalar error from 1.4(0.9) mm to 0.9(0.5) mm (36% improvement). With calibration, 97% of all electrodes would be within 2 mm of the intended target as opposed to 81% before calibration. There was no significant correlation between the degree of error and clinical outcome from bilateral subthalamic nucleus DBS (R = 0.07).
  
  
  CONCLUSIONS
  After calibration of a systematic targeting error an MR image-guided stereotactic approach would be expected to deliver 97% of all electrodes to within 2 mm of the intended target point with a single brain pass.
authors.affiliation: Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, University College London, London, United Kingdom.
authors.forename: Etienne M
authors.initials: EM
authors.lastname: Holl
authors.forename: Erika A
authors.initials: EA
authors.lastname: Petersen
authors.forename: Thomas
authors.initials: T
authors.lastname: Foltynie
authors.forename: Irene
authors.initials: I
authors.lastname: Martinez-Torres
authors.forename: Patricia
authors.initials: P
authors.lastname: Limousin
authors.forename: Marwan I
authors.initials: MI
authors.lastname: Hariz
authors.forename: Ludvic
authors.initials: L
authors.lastname: Zrinzo
mesh_terms: D001921:Brain / Q000033:anatomy & histology / Q000601:surgery*; D046690:Deep Brain Stimulation / Q000379:methods*; D004567:Electrodes, Implanted / Q000592:standards; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D009069:Movement Disorders / Q000628:therapy; D038361:Neuronavigation / Q000379:methods*; D017063:Outcome Assessment, Health Care / Q000379:methods; D011183:Postoperative Complications / Q000517:prevention & control; D013238:Stereotaxic Techniques / Q000592:standards*; D025321:Surgery, Computer-Assisted / Q000379:methods*