Advances in Technical Aspects of Deep Brain Stimulation Surgery

Background: Deep brain stimulation has become an established technology for the treatment of patients with a wide variety of conditions, including movement disorders, psychiatric disorders, epilepsy, and pain. Surgery for implantation of DBS devices has enhanced our understanding of human physiology, which in turn has led to advances in DBS technology. Our group has previously published on these advances, proposed future developments, and examined evolving indications for DBS. Summary: The crucial roles of structural MR imaging pre-, intra-, and post-DBS procedure in target visualization and confirmation of targeting are described, with discussion of new MR sequences and higher field strength MRI enabling direct visualization of brain targets. The incorporation of functional and connectivity imaging in procedural workup and their contribution to anatomical modelling is reviewed. Various tools for targeting and implanting electrodes, including frame-based, frameless, and robot-assisted, are surveyed, and their pros and cons are described. Updates on brain atlases and various software used for planning target coordinates and trajectories are presented. The pros and cons of asleep versus awake surgery are discussed. The role and value of microelectrode recording and local field potentials are described, as well as the role of intraoperative stimulation. Technical aspects of novel electrode designs and implantable pulse generators are presented and compared.

Automated summary

Background: Deep brain stimulation (DBS) is widely used in the treatment of movement disorders, psychiatric disorders, epilepsy, and pain. Surgery for DBS implantation has advanced our understanding of human physiology and led to improvements in DBS technology. This article provides an overview of the role of structural MR imaging and new imaging techniques in visualizing brain targets, as well as the tools and techniques used for targeting and implanting electrodes. The article also discusses the use of functional and connectivity imaging, the pros and cons of different surgical approaches, and the technical aspects of novel electrode designs.