Both authors contributed equally and should therefore be considered as first authors.
Article first published online: 4 JAN 2012
Copyright © 2012 Movement Disorder Society
Volume 27, Issue 4, pages 544–548, April 2012
How to Cite
Reese, R., Pinsker, M. O., Herzog, J., Wodarg, F., Steigerwald, F., Pötter-Nerger, M., Falk, D., Deuschl, G., Mehdorn, H. M. and Volkmann, J. (2012), The atypical subthalamic nucleus—An anatomical variant relevant for stereotactic targeting. Mov. Disord., 27: 544–548. doi: 10.1002/mds.24902
Relevant conflicts of interest/financial disclosures: R.R. received speaking honoraria from Medtronic. M.O.P. received speaking honoraria from Medtronic. D.F. received speaking honoraria from Medtronic. G.D. received grant support for conducting a multicenter study. H.M.M. received speaking honoraria and consultant fees from Medtronic. J.V. received honoraria for lectures, consulting fees, and grant support from Medtronic.
Full financial disclosures and author roles may be found in the online version of this article.
- Issue published online: 4 APR 2012
- Article first published online: 4 JAN 2012
- Manuscript Accepted: 1 DEC 2011
- Manuscript Revised: 24 NOV 2011
- Manuscript Received: 22 JUL 2011
- T2 sequences;
- stereotactic atlas;
- Parkinson's disease
The improvement of PD motor symptoms by DBS of the STN depends on exact targeting.
A combination of MRI and multitrajectory microrecordings was used for localization of the STN in a group of 228 consecutive PD patients.
In 1% of our cases, the STN was consistently shifted in the anterior (3.3 ± 0.8mm) and medial (3.0 ± 0.9mm) direction within the target plane, compared to controls. Adjustment of the original target coordinates after intraoperative reevaluation of the MRI and confirmation by typical subthalamic neuronal recordings along the deviant trajectory allowed the implantation of clinically effective electrodes in all cases. The relative improvement of the motor UPDRS at 6-months follow-up in patients with an atypical and typical STN was comparable.
An atypical position of the STN does not need to complicate DBS surgery, if detected by a combination of MRI-based targeting and electrophysiological guidance. © 2012 Movement Disorder Society