A multi-modal approach to computer-assisted deep brain stimulation trajectory planning.
OBJECTIVE
Both frame-based and frameless approaches to deep brain stimulation (DBS) require planning of insertion trajectories that mitigate hemorrhagic risk and loss of neurological function. Currently, this is done by manual inspection of multiple potential electrode trajectories on MR-imaging data. We propose and validate a method for computer-assisted DBS trajectory planning.


METHODS
Our framework integrates multi-modal MRI analysis (T1w, SWI, TOF-MRA) to compute suitable DBS trajectories that optimize the avoidance of specific critical brain structures. A cylinder model is used to process each trajectory and to evaluate complex surgical constraints described via a combination of binary and fuzzy segmented datasets. The framework automatically aggregates the multiple constraints into a unique ranking of recommended low-risk trajectories. Candidate trajectories are represented as a few well-defined cortical entry patches of best-ranked trajectories and presented to the neurosurgeon for final trajectory selection.


RESULTS
The proposed algorithm permits a search space containing over 8,000 possible trajectories to be processed in less than 20 s. A retrospective analysis on 14 DBS cases of patients with severe Parkinson's disease reveals that our framework can improve the simultaneous optimization of many pre-formulated surgical constraints. Furthermore, all automatically computed trajectories were evaluated by two neurosurgeons, were judged suitable for surgery and, in many cases, were judged preferable or equivalent to the manually planned trajectories used during the operation.


CONCLUSIONS
This work provides neurosurgeons with an intuitive and flexible decision-support system that allows objective and patient-specific optimization of DBS lead trajectories, which should improve insertion safety and reduce surgical time.
McConnell Brain Imaging Centre, Montreal Neurological Institute, 3801 University Street, Montreal, QC H3A 2B4, Canada. silvain.beriault@mail.mcgill.ca
Silvain
S
Bériault
Fahd Al
FA
Subaie
D Louis
DL
Collins
Abbas F
AF
Sadikot
G Bruce
GB
Pike
D000368:Aged; D000465:Algorithms; D001921:Brain / Q000473:pathology; D046690:Deep Brain Stimulation; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D038361:Neuronavigation / Q000379:methods; D010300:Parkinson Disease / Q000628:therapy; D013813:Therapy, Computer-Assisted / Q000379:methods*