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Directional DBS Leads Show Large Deviations from their Intended Implantation Orientation

View ORCID ProfileTA Dembek, M Hoevels, A Hellerbach, View ORCID ProfileA Horn, JN Petry-Schmelzer, J Borggrefe, J Wirths, HS Dafsari, MT Barbe, V Visser-Vandewalle, H Treuer
doi: https://doi.org/10.1101/631325
TA Dembek
1Department of Neurology, University Hospital of Cologne, Germany
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  • For correspondence: till.dembek@uk-koeln.de
M Hoevels
2Department of Stereotactic and Functional Neurosurgery, University Hospital of Cologne, Germany
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A Hellerbach
2Department of Stereotactic and Functional Neurosurgery, University Hospital of Cologne, Germany
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A Horn
3Movement Disorders & Neuromodulation Unit, Department for Neurology, Charité – University Medicine Berlin, Germany
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JN Petry-Schmelzer
1Department of Neurology, University Hospital of Cologne, Germany
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J Borggrefe
4Division of Neuroradiology, Institute of Diagnostic and Interventional Radiology, University Hospital of Cologne, Germany
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J Wirths
2Department of Stereotactic and Functional Neurosurgery, University Hospital of Cologne, Germany
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HS Dafsari
1Department of Neurology, University Hospital of Cologne, Germany
5National Parkinson Foundation International Centre of Excellence, King’s College London, United Kingdom
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MT Barbe
1Department of Neurology, University Hospital of Cologne, Germany
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V Visser-Vandewalle
2Department of Stereotactic and Functional Neurosurgery, University Hospital of Cologne, Germany
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H Treuer
2Department of Stereotactic and Functional Neurosurgery, University Hospital of Cologne, Germany
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Abstract

Objective Lead orientation is a new degree of freedom with directional deep brain stimulation (DBS) leads. We investigated how prevalent deviations from the intended implantation direction are in a large patient cohort.

Methods The Directional Orientation Detection (DiODe) algorithm to determine lead orientation from postoperative CT scans was implemented into the open-source Lead-DBS toolbox. Lead orientation was analysed in 100 consecutive patients (198 leads). Different anatomical targets and intraoperative setups were compared.

Results Deviations of up to 90° from the intended implantation direction were observed. Deviations of more than 30° were seen in 42 % of the leads and deviations of more than 60° in about 11 % of the leads. Deviations were independent from the neuroanatomical target and the stereotactic frame but increased depending on which microdrive was used.

Discussion Our results indicate that large deviations from the intended implantation direction are a common phenomenon in directional leads. Postoperative determination of lead orientation is thus mandatory for investigating directional DBS.

Full Disclosures Till A. Dembek reports speaker honoraria from Medtronic and Boston Scientific.

Mauritius Hoevels has nothing to disclose.

Alexandra Hellerbach has nothing to disclose.

Andreas Horn reports speaker honoraria from Medtronic.

Jan Niklas Petry-Schmelzer reports travel grants from Boston Scientific.

Jan Borggrefe has nothing to disclose.

Jochen Wirths reports travel grants from Boston Scientific.

Haidar Salimi-Dafsari reports honoraria from Medtronic and Boston Scientific.

Michael T. Barbe reports grants from Medtronic and Boston Scientific.

Veerle Visser-Vandewalle is a member of the advisory boards and reports consultancies for Medtronic, Boston Scientific and St Jude Medical. She received a grant from SAPIENS Steering Brain Stimulation. Harald Treuer has nothing to disclose.

Footnotes

  • Mauritius Hoevels – mauritius.hoevels{at}uk-koeln.de, Alexandra Hellerbach – alexandra.hellerbach{at}uk-koeln.de, Andreas Horn – andreas.horn{at}charite.de, Jan Niklas Petry-Schmelzer – jan.petry-schmelzer{at}uk-koeln.de, Jan Borggrefe – jan.borggrefe{at}uk-koeln.de, Jochen Wirths – jochen.wirths{at}uk-koeln.de, Haidar Salimi-Dafsari – haidar.salimi-dafsari{at}uk-koeln.de, Michael T. Barbe – michael.barbe{at}uk-koeln.de, Veerle Visser-Vandewalle – veerle.visser-vandewalle{at}uk-koeln.de, Harald Treuer – harald.treuer{at}uk-koeln.de

  • Declarations of interest: None.

  • Funding: This investigator-initiated trial did not receive additional funding.

  • https://www.lead-dbs.org

Copyright 
The copyright holder for this preprint is the author/funder, who has granted bioRxiv a license to display the preprint in perpetuity. It is made available under a CC-BY-NC 4.0 International license.
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Posted May 08, 2019.
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Directional DBS Leads Show Large Deviations from their Intended Implantation Orientation
TA Dembek, M Hoevels, A Hellerbach, A Horn, JN Petry-Schmelzer, J Borggrefe, J Wirths, HS Dafsari, MT Barbe, V Visser-Vandewalle, H Treuer
bioRxiv 631325; doi: https://doi.org/10.1101/631325
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Directional DBS Leads Show Large Deviations from their Intended Implantation Orientation
TA Dembek, M Hoevels, A Hellerbach, A Horn, JN Petry-Schmelzer, J Borggrefe, J Wirths, HS Dafsari, MT Barbe, V Visser-Vandewalle, H Treuer
bioRxiv 631325; doi: https://doi.org/10.1101/631325

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