Determining the position and size of the subthalamic nucleus based on magnetic resonance imaging results in patients with advanced Parkinson disease
- 1 March 2004
- journal article
- Published by Journal of Neurosurgery Publishing Group (JNSPG) in Journal of Neurosurgery
- Vol. 100 (3), 541-546
- https://doi.org/10.3171/jns.2004.100.3.0541
Abstract
The subthalamic nucleus (STN) is a target in surgery for Parkinson disease, but its location according to brain atlases compared with its position on an individual patient's magnetic resonance (MR) images is incompletely understood. In this study both the size and location of the STN based on MR images were compared with those on the Talairach and Tournoux, and Schaltenbrand and Wahren atlases. The position of the STN relative to the midcommissural point was evaluated on 18 T2-weighted MR images (2-mm slices). Of 35 evaluable STNs, the most anterior, posterior, medial, and lateral borders were determined from axial images, dorsal and ventral borders from coronal images. These methods were validated using histological measurements in one case in which a postmortem examination was performed. The mean length of the anterior commissure-posterior commissure was 25.8 mm. Subthalamic nucleus borders derived from MR imaging were highly variable: anterior, 4.1 to -3.7 mm relative to the midcommissural point; posterior, 4.2 to 10 mm behind the midcommissural point; medial, 7.9 to 12.1 mm from the midline; lateral, 12.3 to 15.4 mm from the midline; dorsal, 0.2 to 4.2 mm below the intercommissural plane; and ventral, 5.7 to 9.9 mm below the intercommissural plane. The position of the anterior border on MR images was more posterior, and the medial border more lateral, than its position in the brain atlases. The STN was smaller on MR images compared with its size in atlases in the anteroposterior (mean 5.9 mm), mediolateral (3.7 mm), and dorsoventral (5 mm) dimensions. The size and position of the STN are highly variable, appearing to be smaller and situated more posterior and lateral on MR images than in atlases. Care must be taken in relying on coordinates relative to the commissures for targeting of the STN.This publication has 12 references indexed in Scilit:
- Long-Term Electrical Inhibition of Deep Brain Targets in Movement DisordersMovement Disorders, 2008
- Magnetic Resonance Imaging-Based Morphometry and Landmark Correlation of Basal Ganglia NucleiActa Neurochirurgica, 2002
- Lack of agreement between direct magnetic resonance imaging and statistical determination of a subthalamic target: the role of electrophysiological guidanceJournal of Neurosurgery, 2002
- Implantation of deep brain stimulators into subthalmic nucleus: technical approach and magnetic imaging—verified electrode locationsJournal of Neurosurgery, 2002
- DepartmentsNeurology, 2000
- Bilateral subthalamic stimulation for Parkinson's disease by using three-dimensional stereotactic magnetic resonance imaging and electrophysiological guidanceJournal of Neurosurgery, 2000
- Double-blind evaluation of subthalamic nucleus deep brain stimulation in advanced Parkinson's diseaseNeurology, 1998
- The Subthalamic Nucleus in Parkinsonʼs Disease and Progressive Supranuclear PalsyJournal of Neuropathology and Experimental Neurology, 1997
- Bilateral subthalamic nucleus stimulation for severe Parkinson's diseaseMovement Disorders, 1995
- Verification of the Schaltenbrand and Wahren stereotactic atlasActa Neurochirurgica, 1994