OBJECTIVE: This retrospective study aims to analyze hemorrhage complications in patients undergoing deep brain stimulation (DBS) surgery, focusing on the impact of imaging modalities and trajectory planning. METHODS: We conducted a retrospective review of patients who underwent DBS at a single institution from September 2018 to February 2023. Surgical planning data were analyzed using a combination of 1.5 Tesla(T) and 3.0 T Magnetic resonance image (MRI) for trajectory planning. Trajectories were classified into four types (Type 1-4) based on the proximity of vascular structures within 2 mm on preoperative MRI scans, as defined in this study. Hemorrhage presence was evaluated through postoperative computed tomography (CT) scans. RESULTS: Out of 200 patients analyzed, Type 1 trajectories (no vascular structures within 2 mm on both MRIs) accounted for 72.70% of cases with the lowest hemorrhage rate. Significant differences in hemorrhage rates were observed among the types, with higher risks associated with Type 4 trajectories. Additionally, significant variations in vascular structure types were noted across DBS targets, with STN showing the highest risk. CONCLUSION: Meticulous trajectory planning using both 1.5T and 3.0T MRI is crucial in minimizing hemorrhagic complications in DBS. The study underscores the need for precise imaging and planning to enhance patient safety and surgical outcomes.