Objective: To characterize the intrinsic deep brain stimulation (DBS) lead migration as it relates to different deep brain targets.

Background: Effective DBS relies on careful preoperative planning and accurate placement of the electrode at its desired target. A small amount of placement error is inevitable, with multiple possible contributing factors including human error, pneumocephalus, release of cerebrospinal fluid, brain shift, anchoring devices, and inherent differences in brain tissue stiffness. [1, 2, 3, 4] To date, there are no studies comparing the intrinsic directionality of the error as it relates to different deep brain targets.

Method: We retrospectively analyzed patients with DBS lead placement in the subthalamic nucleus (STN), ventral intermediate nucleus of the thalamus (VIM), and globus pallidus internus (GPI). Intraoperative computed tomography (CT) of the head was acquired once the left-sided cannula with DBS lead was placed. Repeat intraoperative CT was completed after removal of the cannula to assess lead migration. The directionality of lead migration in the x, y, and z planes was noted and radial error was calculated. Analysis of variance was performed to determine statistical significance.

Results: One hundred and forty-three patients were included. Mean age was 67.9 years (SD 12.0). The STN was targeted in 70 (49%) patients, VIM was targeted in 46 (32%), and GPI was targeted in 27 (19%). Mean radial error of the cannula from the planned target was 0.84 mm +/- 0.46. There was no significant difference in cannula radial error when comparing STN, VIM, and GPI (mean 0.91 +/- 0.44 mm, 0.80 +/- 0.49 mm, 0.71 +/- 0.45 mm, respectively, p=0.141). After the cannula was removed, there was a significant difference in x-axis displacement of the electrode between STN, VIM, and GPI (mean 0.54 +/- 0.38 mm, 0.35 +/- 0.32 mm, 0.06 +/- 0.30 mm, respectively, p < 0.001). There was a significant difference in y-axis displacement of the electrode between STN, VIM, and GPI (mean -0.75 +/- 0.52 mm, -0.06 +/- 0.43 mm, -0.14 +/- 0.38 mm, respectively, p < 0.001).

Conclusion: Removing the guiding cannula in DBS surgery causes a predictable lead migration that varies depending on the target. In our study, leads targeting the STN were displaced more medially and posteriorly compared to VIM and GPI targets. Understanding intrinsic lead migration can inform preoperative planning and may lead to more accurate final placement of DBS electrodes.

References: 1. Zhang DY, Pearce JJ, Petrosyan E, Borghei A, Byrne RW, Sani S. Minimizing pneumocephalus during deep brain stimulation surgery. Clin Neurol Neurosurg. 2024 Mar;238:108174. doi: 10.1016/j.clineuro.2024.108174. Epub 2024 Feb 16. PMID: 38422743.
2. Liang AS, Ginalis EE, Jani R, Hargreaves EL, Danish SF. Frameless Robotic-Assisted Deep Brain Stimulation With the Mazor Renaissance System. Oper Neurosurg (Hagerstown). 2022 Mar 1;22(3):158-164. doi: 10.1227/ONS.0000000000000050. PMID: 35166717.
3. Wang T, Pan Y, Zhang C, Zhan S, Sun B, Li D. Lead fixation in deep brain stimulation: comparison of three lead anchoring devices in China. BMC Surg. 2019 Jul 15;19(1):92. doi: 10.1186/s12893-019-0558-9. PMID: 31307448; PMCID: PMC6631761.
4. Wu C, Alizadeh M, Kramer MK, Kroen MB, Ziechmann R, Mohamed FB, Wu Q, Johnson CL. Deep Brain Stimulation Electrode Deviations are Associated With Brain Stiffness Interfaces Measured by Magnetic Resonance Elastography. Oper Neurosurg (Hagerstown). 2025 Feb 20. doi: 10.1227/ons.0000000000001523. Epub ahead of print. PMID: 39976434.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/intraoperative-deep-brain-stimulation-intrinsic-lead-migration/