title: Comparison of the Stereotactic Accuracies of Function-Guided Deep Brain Stimulation, Calculated Using Multitrack Target Locations Geometrically Inferred from Three-Dimensional Trajectory Rotations, and of Magnetic Resonance Imaging-Guided Deep Brain Stimulation and Outcomes.
abstract: OBJECTIVE
  In previous studies, multitrack trajectories in deep brain stimulation (DBS) have usually been approximated. Using a geometrically more accurate method, we compared the stereotactic accuracy of DBS with multitrack microelectrode recording and awake stimulation (function group) and MRI-guided DBS (MRI group).
  
  
  METHODS
  One hundred and seventy-two leads used in DBS between April 2014 and January 2016 were evaluated for stereotactic errors. Targets were the subthalamic nucleus (STN, 139 leads) or globus pallidus interna (GPi, 33 leads). We geometrically calculated shifted-track targets by considering the three-dimensional stereotactic ring and arc rotations. Stereotactic errors were calculated using Euclidean distances perpendicular to trajectories. Motor outcomes according to the Unified Parkinson's Disease Rating Scale (UPDRS) part III, improvement percentages by stimulations, were analyzed in 24 patients with 1 year follow-ups.
  
  
  RESULTS
  Functional evaluation tended to increase stereotactic errors in the STN function group (n = 129; 1.4 ± 0.7 mm) more than in the STN MRI group (n = 10; 1.0 ± 0.6 mm; P = 0.06). Leads with higher stereotactic errors (n = 65; 1.6 ± 0.7 mm; P < 0.001) than the center-track leads (n = 64; 1.2 ± 0.7 mm) were selectively track shifted. Track-shifted leads approached MRI targets in 86% (56/65 leads). Lower stereotactic errors tended to correlate with a better outcome (P = 0.095). Distances to MRI targets >2.5 mm tended to relate to a worse outcome (P = 0.087). Stereotactic errors were lower (n = 33; 0.9 ± 0.5 mm) in the GPi MRI group.
  
  
  CONCLUSIONS
  Multitrack DBS using intraoperative functional evaluation resulted in worse stereotactic accuracy than did MRI-guided DBS. However, track shifts in function-guided DBS can approach MRI targets effectively.
authors.affiliation: Department of Neurosurgery, Asan Medical Center, Seoul, Korea.
authors.forename: Seong-Cheol
authors.initials: SC
authors.lastname: Park
authors.affiliation: Department of Neurology, Asan Medical Center, Seoul, Korea; College of Medicine, University of Ulsan, Seoul, Korea.
authors.forename: Chong Sik
authors.initials: CS
authors.lastname: Lee
authors.affiliation: Department of Neurology, Asan Medical Center, Seoul, Korea.
authors.forename: Seok Min
authors.initials: SM
authors.lastname: Kim
authors.affiliation: Department of Neurology, Asan Medical Center, Seoul, Korea.
authors.forename: Eu Jene
authors.initials: EJ
authors.lastname: Choi
authors.affiliation: Department of Neurosurgery, Asan Medical Center, Seoul, Korea; College of Medicine, University of Ulsan, Seoul, Korea. Electronic address: jklee2@icloud.com.
authors.forename: Jung Kyo
authors.initials: JK
authors.lastname: Lee
mesh_terms: D002543:Cerebral Hemorrhage / Q000209:etiology; D046690:Deep Brain Stimulation / Q000009:adverse effects / Q000379:methods* / Q000592:standards; D003951:Diagnostic Errors; D004867:Equipment Design; D005260:Female; D006801:Humans; D053783:Magnetic Resonance Imaging, Interventional; D008297:Male; D008839:Microelectrodes; D008875:Middle Aged; D010300:Parkinson Disease / Q000628:therapy*; D011596:Psychomotor Disorders / Q000209:etiology; D012399:Rotation; D013238:Stereotaxic Techniques / Q000592:standards; D016896:Treatment Outcome
keywords: Deep brain stimulation; Intraoperative stimulation; MRI guided; Outcome; Stereotactic error