Variability of the subthalamic nucleus: The case for direct MRI guided targeting

Because of concerns about direct visualization of the subthalamic nucleus (STN) on magnetic resonance imaging (MRI), many functional neurosurgeons continue to rely on atlas-based coordinates to reach this target. T2-weighted MRI does allow direct visualisation of the STN. In order to compare the coordinates of the target point within the visualised STN with those obtained from standard brain atlases, the preoperative stereotactic T2-weighted MRI used to implant 55 deep brain stimulation electrodes in the visualised STN of 29 consecutive patients with Parkinson's disease treated in two European centres were studied. The coordinates of the directly visualised STN were significantly different from those of the atlas target. Variability of the position of the STN may render direct visualisation a more accurate means of targeting this nucleus.

[1]  A L Benabid,et al.  Deep brain stimulation of the subthalamic nucleus for Parkinson's disease: methodologic aspects and clinical criteria. , 2000, Neurology.

[2]  R. Iansek,et al.  Deep brain stimulation of the subthalamic nucleus in Parkinson's disease , 2002, The Medical journal of Australia.

[3]  M. Hariz,et al.  Stereotactic imaging of the pallidal target , 2002, Movement disorders : official journal of the Movement Disorder Society.

[4]  Peter Brown,et al.  Intra-operative recordings of local field potentials can help localize the subthalamic nucleus in Parkinson's disease surgery , 2006, Experimental Neurology.

[5]  Y. Agid,et al.  Bilateral subthalamic stimulation for Parkinson's disease by using three-dimensional stereotactic magnetic resonance imaging and electrophysiological guidance. , 2000, Journal of neurosurgery.

[6]  Clement Hamani,et al.  Correspondence of microelectrode mapping with magnetic resonance imaging for subthalamic nucleus procedures. , 2005, Surgical neurology.

[7]  Abdelhamid Benazzouz,et al.  Pretargeting for the Implantation of Stimulation Electrodes into the Subthalamic Nucleus: A Comparative Study of Magnetic Resonance Imaging and Ventriculography , 2006, Neurosurgery.

[8]  Tarek A. Yousry,et al.  A Quick and Universal Method for Stereotactic Visualization of the Subthalamic Nucleus before and after Implantation of Deep Brain Stimulation Electrodes , 2004, Stereotactic and Functional Neurosurgery.

[9]  Didier Dormont,et al.  Is the subthalamic nucleus hypointense on T2-weighted images? A correlation study using MR imaging and stereotactic atlas data. , 2004, AJNR. American journal of neuroradiology.

[10]  G. Schaltenbrand,et al.  Atlas for Stereotaxy of the Human Brain , 1977 .

[11]  M Brock,et al.  Results of chronic subthalamic nucleus stimulation for Parkinson's disease: a 1-year follow-up study. , 2002, Surgical neurology.

[12]  A. Benabid,et al.  Deep brain stimulation of the subthalamic nucleus in Parkinson's Disease 1993 – 2003: where are we 10 years on? , 2004, British journal of neurosurgery.

[13]  Erich O. Richter,et al.  Determining the position and size of the subthalamic nucleus based on magnetic resonance imaging results in patients with advanced Parkinson disease. , 2004, Journal of neurosurgery.