Transcranial direct current stimulation in patients after decompressive craniectomy: a finite element model to investigate factors affecting the cortical electric field

OBJECTIVE: To simulate the process of transcranial direct current stimulation (tDCS) on patients after decompressive craniectomy (DC), and to model cortical electric field distributions under different electrode montages, we constructed a finite element model that represented the human head at high resolution. METHODS: Using computed tomography images, we constructed a human head model with high geometrical similarity. The removed bone flap was simplified to be circular with a diameter of 12 cm. We then constructed finite element models according to bioelectrical parameters. Finally, we simulated tDCS on the finite element models under different electrode montages. RESULTS: Inward current had a linear relationship with peak electric field value, but almost no effect on electric field distribution. If the anode was not over the skull hole (configuration 2), there was almost no difference in electric field magnitude and focality between the circular and square electrodes. However, if the anode was right over the hole (configuration 1), the circular electrodes led to higher peak electric field values and worse focality. In addition, configuration 1 significantly decreased focality compared with configuration 2. CONCLUSION: Our results might serve as guidelines for selecting current and electrode montage settings when performing tDCS on patients after DC.