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Background <p>Deep brain stimulation (DBS) targeting the centromedian-parafascicular (CM-pf) thalamic nucleus is a promising yet challenging intervention for patients with disorders of consciousness (DoC). These patients often present with significant cerebral deformations, which render conventional, atlas-based surgical planning inaccurate. This case series reports the novel application of a Thalamic Region-Based Non-Rigid Registration Technique (NRRT) integrated with a surgical robot to overcome this challenge, demonstrating its feasibility and precision for the first time in this specific patient population.</p> Case presentation <p>We present a series of four patients with chronic DoC (3 males, 1 female; age range 19–66 years) due to varying etiologies (trauma, encephalitis, brainstem hemorrhage/infarction). All patients exhibited minimally conscious state (MCS) and two had significant hydrocephalus causing brain deformation. Each patient underwent robot-assisted DBS implantation in the CM-pf complex. Preoperatively, we compared planned targets from conventional manual methods and the novel NRRT method. Postoperative imaging revealed that the final electrode positions were consistently closer to the NRRT-planned targets than the conventional ones, with a mean vector error of less than 0.4 mm in the X and Y axes. The procedure was safely completed in all cases without surgical complications. The Coma Recovery Scale-Revised (CRS-R) scores improved postoperatively in all patients, with a median score increase of 7 points.</p> Conclusions <p>This case series provides initial real-world evidence that NRRT-assisted robotic DBS is a feasible and accurate approach for targeting thalamic nuclei in patients with DoC and distorted brain anatomy. The technique allows for personalized surgical planning that may optimize electrode placement. The observed clinical improvements, while encouraging, require cautious interpretation due to the possibility of spontaneous recovery. This report highlights the potential of advanced image registration technologies to address a fundamental problem in stereotactic surgery and warrants further investigation in larger studies.</p> Trial registration <p>Our study has been verified by the Chinese Clinical Trial Registry with the registration number: ChiCTR2400085855, and the registration date is June 19, 2024.</p>

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Nonlinear segmentation and positioning of thalamic nuclei for deep brain stimulation implantation assisted by surgical robot in patients with disorders of consciousness: a technical report

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年1月19日

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  • Dongsheng Liu,
  • Tianqing Cao,
  • Yuhan Shang,
  • Mengfei Liu,
  • Panxi Sun,
  • Nan Wang,
  • Yijun Dong,
  • Yupeng Guo,
  • Dawei Kong,
  • Zhuhuan Song,
  • Lei Liu,
  • Guangming Zhang,
  • Peiling Wong,
  • Shenghong He,
  • Thomas Simpson,
  • Xunanjun Guo,
  • Bozhou Men,
  • Yawei Kuang,
  • Xiaosong Wang,
  • Guoqiang Chen,
  • Shaoya Yin,
  • Yi Yang

摘要

Background

Deep brain stimulation (DBS) targeting the centromedian-parafascicular (CM-pf) thalamic nucleus is a promising yet challenging intervention for patients with disorders of consciousness (DoC). These patients often present with significant cerebral deformations, which render conventional, atlas-based surgical planning inaccurate. This case series reports the novel application of a Thalamic Region-Based Non-Rigid Registration Technique (NRRT) integrated with a surgical robot to overcome this challenge, demonstrating its feasibility and precision for the first time in this specific patient population.

Case presentation

We present a series of four patients with chronic DoC (3 males, 1 female; age range 19–66 years) due to varying etiologies (trauma, encephalitis, brainstem hemorrhage/infarction). All patients exhibited minimally conscious state (MCS) and two had significant hydrocephalus causing brain deformation. Each patient underwent robot-assisted DBS implantation in the CM-pf complex. Preoperatively, we compared planned targets from conventional manual methods and the novel NRRT method. Postoperative imaging revealed that the final electrode positions were consistently closer to the NRRT-planned targets than the conventional ones, with a mean vector error of less than 0.4 mm in the X and Y axes. The procedure was safely completed in all cases without surgical complications. The Coma Recovery Scale-Revised (CRS-R) scores improved postoperatively in all patients, with a median score increase of 7 points.

Conclusions

This case series provides initial real-world evidence that NRRT-assisted robotic DBS is a feasible and accurate approach for targeting thalamic nuclei in patients with DoC and distorted brain anatomy. The technique allows for personalized surgical planning that may optimize electrode placement. The observed clinical improvements, while encouraging, require cautious interpretation due to the possibility of spontaneous recovery. This report highlights the potential of advanced image registration technologies to address a fundamental problem in stereotactic surgery and warrants further investigation in larger studies.

Trial registration

Our study has been verified by the Chinese Clinical Trial Registry with the registration number: ChiCTR2400085855, and the registration date is June 19, 2024.