Lead-OR: A multimodal platform for deep brain stimulation surgery
Curation statements for this article:-
Curated by eLife
Evaluation Summary:
This manuscript is of interest to clinicians and researchers who are involved in both placement and controlling of the accuracy of the location of deep brain stimulation electrodes. The authors present a software tool combining and correlating the documentation of intraoperative neurophysiological findings with atlas and imaging data. They also show an exemplary validation of their tool in a clinical series of 52 Parkinson disease patients who underwent DBS surgery.
(This preprint has been reviewed by eLife. We include the public reviews from the reviewers here; the authors also receive private feedback with suggested changes to the manuscript. Reviewer #2 agreed to share their name with the authors.)
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Abstract
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.
Methods:
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.
Results:
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.
Conclusions:
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.
Funding:
Deutsche Forschungsgesellschaft (410169619, 424778381), Deutsches Zentrum für Luft- und Raumfahrt (DynaSti), National Institutes of Health (2R01 MH113929), and Foundation for OCD Research (FFOR).
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Author Response
Reviewer #1 (Public Review):
Oxenford and colleagues outline the basic principles of a new software tool which they developed to combine the documentation and correlation of various data sets relevant for the implantation and the control of the location of deep brain stimulation electrodes . The concept behind their Lead-OR tool is a logical extension of a software tool which they have developed earlier - the Lead-DBS package.
Multimodal data representation undoubtedly will be a step forward. It is of particular relevance that the toolbox which is shown will be made openly available by open-source platforms.
The introduction of this new tool holds great promise for future research. In particular, the use of this tool might result in a more uniform recording of the correlation of neurophysiological findings with …
Author Response
Reviewer #1 (Public Review):
Oxenford and colleagues outline the basic principles of a new software tool which they developed to combine the documentation and correlation of various data sets relevant for the implantation and the control of the location of deep brain stimulation electrodes . The concept behind their Lead-OR tool is a logical extension of a software tool which they have developed earlier - the Lead-DBS package.
Multimodal data representation undoubtedly will be a step forward. It is of particular relevance that the toolbox which is shown will be made openly available by open-source platforms.
The introduction of this new tool holds great promise for future research. In particular, the use of this tool might result in a more uniform recording of the correlation of neurophysiological findings with the exact location of deep brain stimulation electrodes and ultimately of clinical outcome. A great advantage of this new Software is also ist flexibility with the option to include other sources as well like new atlases and anatomical data.
The conclusions of this paper are well supported by the data which is shown. In particular the figures nicely support the claims made in the manuscript. The clinical series of 52 patients with Parkinson disease gives an example how the new software can be used. Nevertheless, it will be necessary to demonstrate the feasibility of the tool in future clinical studies.
The software will also be useful when applying segmented leads. The authors could expand on this subject. It is certainly a disadvantage of the current software that recordings of local field potential cannot be incorporated yet. At least this should be possible post hoc.
The discussion touches upon many controversial topics and ambiguous Scenarios but it is overall well balanced. The limitations of the study are outlined very openly.
We would like to thank the reviewer for this accurate summary and their positive words about our manuscript.
Reviewer #2 (Public Review):
Oxenford et. al., describe a novel open-source DBS visualization software package, Lead-OR that aims to fill a gap in the intraoperative visualization of DBS trajectories. While theirs is certainly not the first nor only attempt at achieving this, the described software is unique in combining an open-source approach with integration of multimodality data including integration with the most commonly used planning and microelectrode recording platforms. Their software has the potential to take intraoperative DBS visualization to the next level by combining patient-specific imaging with intraoperative electrophysiology and new normalization tools to incorporate external atlases. While some may find this approach unnecessary given the trend towards decreased reliance on MER in DBS for movement disorders, the tools described will still be useful for retrospective and research analyses. The true potential of LeadOR lies in its future potential as integration across platforms grows and other developers add to its capabilities over time.
We would like to thank the reviewer for this accurate summary and the positive evaluation of our manuscript.
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Evaluation Summary:
This manuscript is of interest to clinicians and researchers who are involved in both placement and controlling of the accuracy of the location of deep brain stimulation electrodes. The authors present a software tool combining and correlating the documentation of intraoperative neurophysiological findings with atlas and imaging data. They also show an exemplary validation of their tool in a clinical series of 52 Parkinson disease patients who underwent DBS surgery.
(This preprint has been reviewed by eLife. We include the public reviews from the reviewers here; the authors also receive private feedback with suggested changes to the manuscript. Reviewer #2 agreed to share their name with the authors.)
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Reviewer #1 (Public Review):
Oxenford and colleagues outline the basic principles of a new software tool which they developed to combine the documentation and correlation of various data sets relevant for the implantation and the control of the location of deep brain stimulation electrodes . The concept behind their Lead-OR tool is a logical extension of a software tool which they have developed earlier - the Lead-DBS package.
Multimodal data representation undoubtedly will be a step forward. It is of particular relevance that the toolbox which is shown will be made openly available by open-source platforms.
The introduction of this new tool holds great promise for future research. In particular, the use of this tool might result in a more uniform recording of the correlation of neurophysiological findings with the exact location of …
Reviewer #1 (Public Review):
Oxenford and colleagues outline the basic principles of a new software tool which they developed to combine the documentation and correlation of various data sets relevant for the implantation and the control of the location of deep brain stimulation electrodes . The concept behind their Lead-OR tool is a logical extension of a software tool which they have developed earlier - the Lead-DBS package.
Multimodal data representation undoubtedly will be a step forward. It is of particular relevance that the toolbox which is shown will be made openly available by open-source platforms.
The introduction of this new tool holds great promise for future research. In particular, the use of this tool might result in a more uniform recording of the correlation of neurophysiological findings with the exact location of deep brain stimulation electrodes and ultimately of clinical outcome. A great advantage of this new Software is also ist flexibility with the option to include other sources as well like new atlases and anatomical data.
The conclusions of this paper are well supported by the data which is shown. In particular the figures nicely support the claims made in the manuscript. The clinical series of 52 patients with Parkinson disease gives an example how the new software can be used. Nevertheless, it will be necessary to demonstrate the feasibility of the tool in future clinical studies.
The software will also be useful when applying segmented leads. The authors could expand on this subject. It is certainly a disadvantage of the current software that recordings of local field potential cannot be incorporated yet. At least this should be possible post hoc.
The discussion touches upon many controversial topics and ambiguous Scenarios but it is overall well balanced. The limitations of the study are outlined very openly.
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Reviewer #2 (Public Review):
Oxenford et. al., describe a novel open-source DBS visualization software package, Lead-OR that aims to fill a gap in the intraoperative visualization of DBS trajectories. While theirs is certainly not the first nor only attempt at achieving this, the described software is unique in combining an open-source approach with integration of multimodality data including integration with the most commonly used planning and microelectrode recording platforms. Their software has the potential to take intraoperative DBS visualization to the next level by combining patient-specific imaging with intraoperative electrophysiology and new normalization tools to incorporate external atlases. While some may find this approach unnecessary given the trend towards decreased reliance on MER in DBS for movement disorders, the …
Reviewer #2 (Public Review):
Oxenford et. al., describe a novel open-source DBS visualization software package, Lead-OR that aims to fill a gap in the intraoperative visualization of DBS trajectories. While theirs is certainly not the first nor only attempt at achieving this, the described software is unique in combining an open-source approach with integration of multimodality data including integration with the most commonly used planning and microelectrode recording platforms. Their software has the potential to take intraoperative DBS visualization to the next level by combining patient-specific imaging with intraoperative electrophysiology and new normalization tools to incorporate external atlases. While some may find this approach unnecessary given the trend towards decreased reliance on MER in DBS for movement disorders, the tools described will still be useful for retrospective and research analyses. The true potential of LeadOR lies in its future potential as integration across platforms grows and other developers add to its capabilities over time.
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