Lead-OR: A multimodal platform for deep brain stimulation surgery.
Lead-OR: A multimodal platform for deep brain stimulation surgery.
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DOI：
10.7554/elife.72929
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发表时间：
2022-05-20
期刊：
影响因子：
7.7
通讯作者：
Horn, Andreas
中科院分区：
文献类型：
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作者：
Oxenford, Simon;Roediger, Jan;Neudorfer, Clemens;Milosevic, Luka;Guttler, Christopher;Spindler, Philipp;Vajkoczy, Peter;Neumann, Wolf-Julian;Kuehn, Andrea;Horn, Andreas
脑深部电刺激（DBS）电极植入轨迹使用术前神经成像进行立体定位定义。为了验证正确的轨迹，可以使用微电极记录（MER）或局部场电位记录来扩展神经解剖信息（由MRI定义），其中神经生理活动模式是从探测手术靶部位的微电极和宏电极记录的。目前，这两种信息来源（成像与电生理学）是分开分析的，而融合两种数据流的方法尚未引入。在这里，我们提出了一种工具，它集成了来自立体定向计划，神经成像，MER和高分辨率图谱数据的资源，以创建植入轨迹的实时可视化。我们基于DBS患者（N = 52）的回顾性队列离线验证了该工具，并介绍了实时平台的一次性使用病例。我们建立了一个开源软件工具，用于DBS手术期间的多模态数据可视化和分析。我们展示了神经成像和电生理记录的功能之间的一般对应关系，并展示了该工具的功能。这种用于多模态数据可视化和分析的新型软件平台具有提高DBS手术准确性的转化潜力。该工具箱是公开提供的，并且可以扩展以与其他软件包集成。Deutsche Forschungsgesellschaft（410169619，424778381）、Deutsches Zentrum für Luft- und Raumfahrt（DynaSti）、美国国立卫生研究院（2 R 01 MH 113929）和强迫症研究基金会（FFOR）。脑深部电刺激是帕金森病患者的既定疗法，也是其他神经系统疾病的新兴选择。电极被植入大脑深处，以刺激精确的大脑区域并控制这些区域的异常大脑活动。例如，帕金森氏病最常见的靶点是一种叫做丘脑底核的结构，它位于大脑的底部，就在脑干的上方。为了确保电极正确放置，外科医生使用各种信息来源来描述患者的大脑解剖结构并决定植入部位。这些数据包括手术前进行的脑部扫描和手术期间记录的大脑活动，以确认预期的植入部位。有时，最后确认步骤产生的大脑活动信号可能会稍微改变手术计划。它代表了临床团队面临的众多挑战之一：分析，吸收和交流在手术过程中收集的数据。Oxenford等人开发了一种软件管道，用于汇总外科医生用于植入电极的数据。这个名为Lead-OR的开源平台可以真实的可视化成像数据和大脑活动记录（称为电生理数据）。目前的设置集成了商业工具和现有的手术规划软件。Oxenford等人对从32名帕金森病患者中收集的数据进行了回顾性测试，这些患者的丘脑底核中植入了电极。该平台显示出成像和电生理数据之间的良好一致性，尽管存在一些不可避免的差异，这些差异是由成像管道和外科手术的限制引起的。Lead-OR还能够纠正大脑移位，这是大脑在头骨中轻微移动的地方。经过进一步验证，这个概念验证软件可以作为外科团队植入电极进行脑深部电刺激的有用决策工具。如果及时实施，它的使用可以提高电极放置的准确性，为患者带来更好的手术结果。它还具有整合来自当前脑映射项目和其他商业手术规划工具的超高分辨率数据的潜力。
Deep brain stimulation (DBS) electrode implant trajectories are stereotactically defined using preoperative neuroimaging. To validate the correct trajectory, microelectrode recordings (MERs) or local field potential recordings can be used to extend neuroanatomical information (defined by MRI) with neurophysiological activity patterns recorded from micro- and macroelectrodes probing the surgical target site. Currently, these two sources of information (imaging vs. electrophysiology) are analyzed separately, while means to fuse both data streams have not been introduced. Here, we present a tool that integrates resources from stereotactic planning, neuroimaging, MER, and high-resolution atlas data to create a real-time visualization of the implant trajectory. We validate the tool based on a retrospective cohort of DBS patients (N = 52) offline and present single-use cases of the real-time platform. We establish an open-source software tool for multimodal data visualization and analysis during DBS surgery. We show a general correspondence between features derived from neuroimaging and electrophysiological recordings and present examples that demonstrate the functionality of the tool. This novel software platform for multimodal data visualization and analysis bears translational potential to improve accuracy of DBS surgery. The toolbox is made openly available and is extendable to integrate with additional software packages. Deutsche Forschungsgesellschaft (410169619, 424778381), Deutsches Zentrum für Luft- und Raumfahrt (DynaSti), National Institutes of Health (2R01 MH113929), and Foundation for OCD Research (FFOR). Deep brain stimulation is an established therapy for patients with Parkinson’s disease and an emerging option for other neurological conditions. Electrodes are implanted deep in the brain to stimulate precise brain regions and control abnormal brain activity in those areas. The most common target for Parkinson’s disease, for instance, is a structure called the subthalamic nucleus, which sits at the base of the brain, just above the brain stem. To ensure electrodes are placed correctly, surgeons use various sources of information to characterize the patient’s brain anatomy and decide on an implant site. These data include brain scans taken before surgery and recordings of brain activity taken during surgery to confirm the intended implant site. Sometimes, the brain activity signals from this last confirmation step may slightly alter surgical plans. It represents one of many challenges for clinical teams: to analyse, assimilate, and communicate data as it is collected during the procedure. Oxenford et al. developed a software pipeline to aggregate the data surgeons use to implant electrodes. The open-source platform, dubbed Lead-OR, visualises imaging data and brain activity recordings (termed electrophysiology data) in real time. The current set-up integrates with commercial tools and existing software for surgical planning. Oxenford et al. tested Lead-OR on data gathered retrospectively from 32 patients with Parkinson’s who had electrodes implanted in their subthalamic nucleus. The platform showed good agreement between imaging and electrophysiology data, although there were some unavoidable discrepancies, arising from limitations in the imaging pipeline and from the surgical procedure. Lead-OR was also able to correct for brain shift, which is where the brain moves ever so slightly in the skull. With further validation, this proof-of-concept software could serve as a useful decision-making tool for surgical teams implanting electrodes for deep brain stimulation. In time, if implemented, its use could improve the accuracy of electrode placement, translating into better surgical outcomes for patients. It also has the potential to integrate forthcoming ultra-high-resolution data from current brain mapping projects, and other commercial surgical planning tools.