ArticleBMC neurology2026
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.
Article in BMC neurology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundDeep 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.
conclusionsThis 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 registrationOur study has been verified by the Chinese Clinical Trial Registry with the registration number: ChiCTR2400085855, and the registration date is June 19, 2024.
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