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Author Notes:

Corresponding Author: Cameron C. McIntyre, Ph.D., Department of Biomedical Engineering, Case Western Reserve University, 2103 Cornell Road, Rm 6224, Cleveland, OH 44106, ccm4@case.edu.

The authors thank St Jude Medical and Medtronic for donation of the DBS devices used in these experimental studies.

CCM is a paid consultant for Boston Scientific Neuromodulation and Kernel, as well as a shareholder in the following companies: Surgical Information Sciences; Autonomic Technologies; Cardionomic; Enspire DBS; Neuros Medical.

HSM is a paid consultant with licensed intellectual property to St Jude Medical.

REG has received grants from Medtronic Inc., Neuropace and MRI Interventions, honoraria from Medtronic Inc and MRI Interventions; and is a paid consultant to St Jude Medical Corp., Medtronic Inc., Neuropace, MRI Interventions, Neuralstem and SanBio.

Authors, KSC, AMN, PRP, JKR, reported no biomedical financial interests or potential conflicts of interest.


Research Funding:

This work was supported by the National Institutes of Health (R01 MH102238).


  • Science & Technology
  • Life Sciences & Biomedicine
  • Clinical Neurology
  • Neurosciences
  • Neurosciences & Neurology
  • Connectomic
  • Electrode
  • Neurosurgery
  • Stereotactic
  • Tractography

Impact of brain shift on subcallosal cingulate deep brain stimulation


Journal Title:

Brain Stimulation


Volume 11, Number 2


, Pages 445-453

Type of Work:

Article | Post-print: After Peer Review


Background: Deep brain stimulation (DBS) of the subcallosal cingulate (SCC) is an emerging experimental therapy for treatment-resistant depression. New developments in SCC DBS surgical targeting are focused on identifying specific axonal pathways for stimulation that are estimated from preoperatively collected diffusion-weighted imaging (DWI) data. However, brain shift induced by opening burr holes in the skull may alter the position of the target pathways. Objectives: Quantify the effect of electrode location deviations on tractographic representations for stimulating the target pathways using longitudinal clinical imaging datasets. Methods: Preoperative MRI and DWI data (planned) were coregistered with postoperative MRI (1 day, near-term) and CT (3 weeks, long-term) data. Brain shift was measured with anatomical control points. Electrode models corresponding to the planned, near-term, and long-term locations were defined in each hemisphere of 15 patients. Tractography analyses were performed using estimated stimulation volumes as seeds centered on the different electrode positions. Results: Mean brain shift of 2.2 mm was observed in the near-term for the frontal pole, which resolved in the long-term. However, electrode displacements from the planned stereotactic target location were observed in the anterior-superior direction in both the near-term (mean left electrode shift: 0.43 mm, mean right electrode shift: 0.99 mm) and long-term (mean left electrode shift: 1.02 mm, mean right electrode shift: 1.47 mm). DBS electrodes implanted in the right hemisphere (second-side operated) were more displaced from the plan than those in the left hemisphere. These displacements resulted in 3.6% decrease in pathway activation between the electrode and the ventral striatum, but 2.7% increase in the frontal pole connection, compared to the plan. Remitters from six-month chronic stimulation had less variance in pathway activation patterns than the non-remitters. Conclusions: Brain shift is an important concern for SCC DBS surgical targeting and can impact connectomic analyses.

Copyright information:

© 2017 Elsevier Inc.

This is an Open Access work distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (http://creativecommons.org/licenses/by-nc-nd/4.0/).

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