Choice of Neurosurgical Planning Software Affects Deep Brain Stimulation Target Co-ordinate Generation.

Background Targeting and co-ordinate derivation are critical steps in deep brain stimulation (DBS). Multiple planning stations are available to assist in this process, yet it is unclear how they compare in their methods and outputs. We hypothesised that planning DBS would generate the same co-ordinates independent of the planning station used. Methods We compared the planning of DBS to the subthalamic nucleus (STN) using three planning stations (Brainlab Elements v2, Medtronic StealthStationTM S8, and Renishaw NeuroInspireTM v6.2.2). Six users (2 consultants / attendings, 2 senior fellows, 2 clinical lecturers / senior residents) planned bilateral STN DBS for the same 10 randomly ordered subjects on each planning station in 3 spaces (native T2 image, AC-PC, stereotactic frame), generating 3240 datapoints. Differences in individual XYZ co-ordinates were analysed per space using parametric statistical tests. Results Mean co-ordinates in image space varied by 0.33mm (Z-plane) between planning stations, with statistically significant differences in the X-plane (Brainlab) and Y- and Z-planes (Renishaw). Mean co-ordinates in AC-PC space varied by a maximum of 1.02mm (Z-plane) with significant differences present in all 3 planes for Renishaw. Mean co-ordinates in stereotactic frame space varied by 0.53mm (Z-plane) with differences present in the X-plane (Brainlab), Y-plane (Renishaw), and Z-plane (all). Between-rater and between-subject analyses did not reveal any significant differences. Conclusions Differences in derived co-ordinates between planning station are present but small (mean <0.5mm across all planes and spaces), albeit with a variance of 1.5mm. Directions of effects were varied and likely represent a complex interaction of multiple proceses. If changing between planning stations, we would recommend a prospective appraisal of lead placement and clinical outcomes. These data highlight that a critical appraisal of the methods used within planning stations is warranted to provide consistent co-ordinate derivation and improved targeting.