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Comparative Study
. 2025 Jul 22;167(1):199.
doi: 10.1007/s00701-025-06619-z.

A comparison of electrophysiological microrecording versus automatic MR-based segmentation to determine subthalamic nucleus boundaries

Camilla de Laurentis  1 , Stéphane Thobois  2   3   4 , Teodor Danaila  2 , Chloe Laurencin  2   4 , Gustavo Polo  1 , Stéphane Prange  2   3   4 , Emile Simon  5
Affiliations
Comparative Study

A comparison of electrophysiological microrecording versus automatic MR-based segmentation to determine subthalamic nucleus boundaries

Camilla de Laurentis et al. Acta Neurochir (Wien). .

Abstract

Purpose: Accurate placement of electrodes within the subthalamic nucleus is critical for deep brain stimulation (STN-DBS) in Parkinson's disease (PD). Our objective was to compare microelectrode recording (MER) and an automatic MR-based segmentation tool (BrainLab ElementsTM) for STN targeting and the determination of STN boundaries.

Methods: Seventy-eight PD patients were included. Electrode placement within the STN and STN entry and exit points were determined by both methods and compared for concordance.

Results: Of 344 trajectories, 269 were inside the STN, with good concordance of both techniques (Fleiss' kappa 0.721, [95%CI 0.623, 0.819]). Concordance of MER and MR-based for the selection of the optimal trajectory was good (Fleiss' kappa 0.693, [95%CI 0.578, 0.808]), with less than 2.75mm difference between MER and MR-based for the STN entry (upper limit of agreement 2.752 [95%CI 2.365 to 3.138] mm; lower limit of agreement -2.406 [95%CI -2.793 to -2.020] mm) and exit points (upper limit of agreement 2.750 [95%CI 2.351 to 3.149] mm; lower limit of agreement -2.577mm [95%CI -2.976 to -2.178]).

Conclusion: We demonstrated that MER and MR-based segmentation have a good concordance to determine STN boundaries during DBS surgery.

Keywords: Deep brain stimulation; Electrophysiology; Ideal trajectory; MRI-based segmentation; Parkinson’s disease.

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Conflict of interest statement

Declarations. Study approval statement: This study protocol was reviewed and approved by the local ethics committee of the Hospices Civils de Lyon (Comité Scientifique et Éthique des Hospices Civils de Lyon), IRB (Internal Review Board) 00013204, AGORA number 23-5439. Human ethics and consent to participate declaration: Informed consent was obtained from all the participants/legal guardian of participants prior to the study, to use their data in a completely anonymized form. Written informed consent was not deemed necessary because the study was conducted using regularly collected data. This study protocol and consent procedure was reviewed and approved by the local ethics committee of the Hospices Civils de Lyon (Comité Scientifique et Éthique des Hospices Civils de Lyon, Lyon, France), approval numbers IRB (Internal Review Board) 00013204, AGORA number 23-5439 (conformité MR004 n°23-5439), decision date 20/05/2024, and non-opposition was collected from patients. The study was in line with local and national guidelines. Our study has therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. Competing interests: C. de Laurentis declares that she has no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. S. Thobois declares honoraria from Boston, Medtronic, Abbvie, Merz, NHC, MDS for consulting, board, or conferences; meeting and travel grant from the MDS and Abbvie. T. Danaila declares honoraria from Abbvie and Orkyn. C. Laurencin declares travel grants from Abbvie, and honoraria from Orphalan. G. Polo declares that he has no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. S. Prange declares honoraria from Abbvie for consulting. E. Simon declares honoraria from Boston & BrainLab for conferences, meeting and travel grant from Boston.

Figures

Fig. 1
Fig. 1
Schematic representation of the subthalamic nucleus boundaries (green) showing the Bland-Altman plots for the comparison of the difference of measurements between MER and MR-based segmentation for the entry (left) and exit (right) points of the subthalamic nucleus. For the entry point (left), a bias of 0.173 mm (95%CI −0.053 to 0.399) was calculated, with an upper limit of agreement (green) of 2.752mm (95%CI 2.365 to 3.138) and a lower limit of agreement (red) of −2.406 mm (95%CI −2.793 to −2.020). For the exit point (right), a bias of 0.086 mm (95%CI −0.147 to 0.320) was calculated, with an upper limit of agreement of 2.750mm (95%CI 2.351 to 3.149) and a lower limit of agreement of −2.577mm (95%CI −2.976 to −2.178)
Fig. 2
Fig. 2
Flowchart synthesizing the workflow illustrated in the present paper. Both methods, electro physiological microrecording (MER) and MRI-based segmentation, were used to determine the best trajectory for each electrode (left). The two methods agreed on choosing the same best trajectory in 85.3% of cases (center). Macrostimulation was performed to select the definitive trajectory for the electrode to be implanted (right): in 76.8% of cases, it confirmed the best trajectory already suggested by both methods; in 5.2% it agreed with the best trajectory of MER, and in 6.5% with the best trajectory of MRI-segmentation. In 11.6% of the studied trajectories, macrostimulation suggested a trajectory other than the best ones of MER and MRI-segmentation as the best to be chosen for implantation
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