Directional DBS leads show large deviations from their intended implantation orientation

Lead orientation is a new degree of freedom with directional deep brain stimulation (DBS) leads. We investigated how prevalent deviations from the intended implantation direction are in a large patient cohort. The Directional Orientation Detection (DiODe) algorithm to determine lead orientation from postoperative CT scans was implemented into the open-source Lead-DBS toolbox. Lead orientation was analyzed in 100 consecutive patients (198 leads). Different anatomical targets and intraoperative setups were compared. Deviations of up to 90° from the intended implantation direction were observed. Deviations of more than 30° were seen in 42% of the leads and deviations of more than 60° in about 11% of the leads. Deviations were independent from the neuroanatomical target and the stereotactic frame but increased depending on which microdrive was used. Our results indicate that large deviations from the intended implantation direction are a common phenomenon in directional leads. Postoperative determination of lead orientation is thus mandatory for investigating directional DBS. •First investigation of lead orientation in patients with directional DBS leads.•Large cohort with n = 100 patients and n = 198 directional DBS leads.•Open-source algorithm to determine lead orientation from postoperative CT scans.•Results show deviations of up to 90° from the intended implantation direction.•More than one in ten leads deviate by more than 60°.