gms | German Medical Science

65th Annual Meeting of the German Society of Neurosurgery (DGNC)

German Society of Neurosurgery (DGNC)

11 - 14 May 2014, Dresden

Modelling volume of tissue activated for deep brain stimulation – First experience with “Boston Scientific’s GUIDE“ software

Meeting Abstract

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  • Gregor A. Bara - Funktionelle Neurochirurgie und Stereotaxie, Neurochirurgische Klinik, Universitätsklinikum Düsseldorf
  • Jaroslaw Maciaczyk - Funktionelle Neurochirurgie und Stereotaxie, Neurochirurgische Klinik, Universitätsklinikum Düsseldorf
  • Jan Vesper - Funktionelle Neurochirurgie und Stereotaxie, Neurochirurgische Klinik, Universitätsklinikum Düsseldorf

Deutsche Gesellschaft für Neurochirurgie. 65. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Dresden, 11.-14.05.2014. Düsseldorf: German Medical Science GMS Publishing House; 2014. DocMI.15.06

doi: 10.3205/14dgnc356, urn:nbn:de:0183-14dgnc3567

Published: May 13, 2014

© 2014 Bara et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Objective: Deep Brain Stimulation has evolved towards a standard clinical treatment for various neurological disorders. Technology wise we have encountered the development of traditional constant voltage neurostimulators towards constant current systems with multi independent power sources allowing field shaping. These new stimulators deliver constant current to the brain tissue, irrespective of impedance changes that occur around the electrode, and enable more specific steering of current towards targeted regions of interest. It is thought that therapeutic efficacy elicitated by DBS largely depends on activation of a specific target volume whereas side effects result from activation of surrounding tissue. Therefore DBS surgery requires precise targeting of the electrode in the brain. However, even with the stereotactic based surgical techniques, excessive programming time is needed for an adequate therapeutic effect. Most often this programming practice is based on trial and error and focuses on acute effects. A visualization system for shaping the electric field in an anatomically appropriate manner could improve clinical outcome whilst reducing side effects as well as decreasing programming time and power consumption. Here we present our experience with Boston Sci’s GUIDE DBS visualization system.

Methods: Target areas were identified via CT-MRT fused imaging. Stereotactic procedures were performed with the Leksell Elekta frame. Intraoperative target finding was supported by micro-electrode recordings as well as clinical testing. Postoperative CT scans were fused with preoperative MRI scans with Boston Sci’s GUIDE DBS visualization system. Basal ganglia were modeled in accordance to the AC-PC line and their position in respect to the postoperative electrode position was visualized. Programming was based on the best calculated volume of electrical tissue activation within this model.

Results: 8 patients were implanted. 7 patients suffered from IPS and underwent electrode implantation into the subthalamic nucleus. 1 patient suffered from essential tremor and underwent implantation into Vim.

Conclusions: A visualization system may offer an improvement of programming in respect to symptom reduction as well as reduction of programming time and minimizing electrical consumption and thus increased battery life. Our experience shows this visualization system to be feasible and easy to use. However, its real life significance has to be revealed in clinical studies.