Navigating Deep Brain Stimulation Targets: A Three-Dimensional Video Guide for Movement Disorders

Deep brain stimulation (DBS) is a well-established treatment for motor circuit disorders such as Parkinson disease, dystonia, and essential tremor, particularly when pharmacological interventions are insufficient.1-3 1-3 The increase in DBS-related publications and the growing number of patients receiving DBS highlight the acceptance and refinement of the procedure.3,4 3,4 Despite its widespread use, comprehensive anatomical knowledge of deep brain nuclei remains critical for enhancing clinical efficacy. Accurate targeting of the complex three-dimensional anatomy of the target nuclei is crucial for maximizing therapeutic effects and minimizing adverse side effects. However, existing anatomical guides often lack depth perception.5,6 5,6 We dissected specimens prepared using the Klingler method,7 7 proceeding sequentially from lateral to medial, medial to lateral, and superior to inferior. We then generated a video guide for three-dimensional models of the DBS target nuclei at each stage using the photogrammetry method (Video 1). Our models were evaluated via augmented reality within a real- world context, and radiological models of these nuclei generated through segmentation were analyzed. Thus, our models and videos offer a novel method for visualizing the complex anatomy of deep brain nuclei, which could help enhance the precision of DBS procedures and may improve patient outcomes. This advanced understanding of spatial anatomical relationships may be beneficial for the continued development and success of DBS therapy.