title: Computational modeling of an endovascular approach to deep brain stimulation.
abstract: OBJECTIVE
  Deep brain stimulation (DBS) therapy currently relies on a transcranial neurosurgical technique to implant one or more electrode leads into the brain parenchyma. In this study, we used computational modeling to investigate the feasibility of using an endovascular approach to target DBS therapy.
  
  
  METHODS
  Image-based anatomical reconstructions of the human brain and vasculature were used to identify 17 established and hypothesized anatomical targets of DBS, of which five were found adjacent to a vein or artery with intraluminal diameter ≥1 mm. Two of these targets, the fornix and subgenual cingulate white matter (SgCwm) tracts, were further investigated using a computational modeling framework that combined segmented volumes of the vascularized brain, finite element models of the tissue voltage during DBS, and multi-compartment axon models to predict the direct electrophysiological effects of endovascular DBS.
  
  
  RESULTS
  The models showed that: (1) a ring-electrode conforming to the vessel wall was more efficient at neural activation than a guidewire design, (2) increasing the length of a ring-electrode had minimal effect on neural activation thresholds, (3) large variability in neural activation occurred with suboptimal placement of a ring-electrode along the targeted vessel, and (4) activation thresholds for the fornix and SgCwm tracts were comparable for endovascular and stereotactic DBS, though endovascular DBS was able to produce significantly larger contralateral activation for a unilateral implantation.
  
  
  CONCLUSIONS
  Together, these results suggest that endovascular DBS can serve as a complementary approach to stereotactic DBS in select cases.
authors.affiliation: Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN 55455, USA.
authors.forename: Benjamin A
authors.initials: BA
authors.lastname: Teplitzky
authors.forename: Allison T
authors.initials: AT
authors.lastname: Connolly
authors.forename: Jawad A
authors.initials: JA
authors.lastname: Bajwa
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Johnson
mesh_terms: D000200:Action Potentials / Q000502:physiology*; D001921:Brain / Q000033:anatomy & histology / Q000098:blood supply; D003198:Computer Simulation; D046690:Deep Brain Stimulation / Q000379:methods* / Q000592:standards; D057510:Endovascular Procedures / Q000379:methods* / Q000592:standards; D005260:Female; D006801:Humans; D008875:Middle Aged; D008953:Models, Anatomic; D012189:Retrospective Studies